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Exploration of experiences and attitudes associated with lung health promotion among Black males with a history of smoking

  • Alicia K. Matthews1,*,
  • Suchanart Inwanna2,3
  • Dami Oyaluade4
  • Alexis Chappel5
  • Jennifer Akufo2
  • Sage J. Kim6
  • Rohan Jeremiah2

1School of Nursing, Columbia University, New York, NY 10001, USA

2College of Nursing, the University of Illinois Chicago, Chicago, IL 60612, USA

3Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 10400 Bangkok, Thailand

4Cancer Center, the University of Illinois Hospital, Chicago, IL 60612, USA

5Northeastern Illinois University, Chicago, IL 60625, USA

6School of Public Health, the University of Illinois Chicago, Chicago, IL 60612, USA

DOI: 10.22514/jomh.2024.005 Vol.20,Issue 1,January 2024 pp.20-34

Submitted: 08 September 2023 Accepted: 26 September 2023

Published: 30 January 2024

*Corresponding Author(s): Alicia K. Matthews E-mail:


To examine knowledge and attitudes about lung health promotion (smoking cessation and lung cancer screening) among Black male smokers in a large Midwestern city in the United States. Semi-structured, in-depth interviews were conducted with 25 study participants. Each interview lasted approximately 45 minutes. Participants also completed a brief (5–10 minutes) survey measuring demographic characteristics, smoking experiences and knowledge and attitudes about lung health promotion activities. Descriptive statistics were used for quantitative data, and deductive thematic analysis for qualitative data analysis. The mean age of study participants was 57.5 years. Eighty-four percent of participants were current smokers, with the majority being daily smokers. Perceived risk for lung cancer was mixed, with 56% of participants endorsing that they considered themselves to be at high or moderate risk and the remaining 44% at low or no risk for lung cancer. Forty percent of participants reported having had a test to check their lungs for cancer. Participants were aware of the health risks associated with smoking but reported limited assistance from providers regarding the receipt of smoking cessation treatments. Awareness of lung cancer screening was limited, but participants expressed openness to screening; however, barriers were anticipated, including costs, fear and a reduced willingness to be screened in the absence of symptoms. Study participants reported limited experiences with lung health promotion activities. Knowledge about the facilitators and barriers can be used to develop health promotion interventions targeting smoking cessation and lung cancer screening.


Tobacco use; Lung cancer screening; Black males; Qualitative; Lung health promotion

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Alicia K. Matthews,Suchanart Inwanna,Dami Oyaluade,Alexis Chappel,Jennifer Akufo,Sage J. Kim,Rohan Jeremiah. Exploration of experiences and attitudes associated with lung health promotion among Black males with a history of smoking. Journal of Men's Health. 2024. 20(1);20-34.


[1] Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco product use among adults—United States, 2020. Morbidity and Mortality Weekly Report. 2022; 71: 397–405.

[2] National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The health consequences of smoking—50 years of progress: a report of the surgeon general. 2014. Available at: (Accessed: 30 January 2019).

[3] Siegel DA, Fedewa SA, Henley SJ, Pollack LA, Jemal A. Proportion of never smokers among men and women with lung cancer in 7 US States. JAMA Oncology. 2021; 7: 302.

[4] Popper HH. Progression and metastasis of lung cancer. Cancer and Metastasis Reviews. 2016; 35: 75–91.

[5] Woodard GA, Jones KD, Jablons DM. Lung cancer staging and prognosis. Cancer Treatment and Research. 2016; 2: 47–75.

[6] Schabath MB, Cote ML. Cancer progress and priorities: lung cancer. Cancer Epidemiology, Biomarkers & Prevention. 2019; 28: 1563–1579.

[7] American Cancer Society. Key statistics for lung cancer. 2020. Available at: (Accessed: 15 February 2023).

[8] Centers for Disease Control and Prevention (CDC). Racial/Ethnic disparities and geographic differences in lung cancer incidence—38 States and the District of Columbia, 1998–2006. Morbidity and Mortality Weekly Report. 2010; 59: 1434–1438.

[9] National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Cancer stat facts: lung and bronchus cancer. 2018. Available at: (Accessed: 15 February 2023).

[10] Alexander LA, Trinidad DR, Sakuma KK, Pokhrel P, Herzog TA, Clanton MS, et al. Why we must continue to investigate menthol’s role in the African American smoking paradox. Nicotine & Tobacco Research. 2016; 18: S91–S101.

[11] DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA: A Cancer Journal for Clinicians. 2019; 69: 211–233.

[12] Abdel-Rahman O. Outcomes of non-metastatic colon cancer patients in relationship to socioeconomic status: an analysis of SEER census tract-level socioeconomic database. International Journal of Clinical Oncology. 2019; 24: 1582–1587.

[13] Abdel-Rahman O. Impact of NCI socioeconomic index on the outcomes of nonmetastatic breast cancer patients: analysis of SEER census tract–level socioeconomic database. Clinical Breast Cancer. 2019; 19: e717–e722.

[14] Gupta A, Omeogu CH, Islam JY, Joshi AR, Akinyemiju TF. Association of area‐level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: analysis of the National Cancer Database. Cancer. 2022; 128: 3099–3108.

[15] DeSantis CE, Siegel RL, Sauer AG, Miller KD, Fedewa SA, Alcaraz KI, et al. Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA: A Cancer Journal for Clinicians. 2016; 66: 290–308.

[16] Coughlin SS, Matthews‐Juarez P, Juarez PD, Melton CE, King M. Opportunities to address lung cancer disparities among African Americans. Cancer Medicine. 2014; 3: 1467–1476.

[17] Aberle DR, Berg CD, Black WC, Church TR, Fagerstrom RM, Galen B, et al. The national lung screening trial: overview and study design. Radiology. 2011; 258: 243–253.

[18] de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. New England Journal of Medicine. 2020; 382: 503–513.

[19] Pham D, Bhandari S, Pinkston C, Oechsli M, Kloecker G. Lung cancer screening registry reveals low-dose CT screening remains heavily underutilized. Clinical Lung Cancer. 2020; 21: e206–e211.

[20] Lillie SE, Fu SS, Fabbrini AE, Rice KL, Clothier B, Nelson DB, et al. What factors do patients consider most important in making lung cancer screening decisions? Findings from a demonstration project conducted in the Veterans Health Administration. Lung Cancer. 2017; 104: 38–44.

[21] Tindle HA, Stevenson Duncan M, Greevy RA, Vasan RS, Kundu S, Massion PP, et al. Lifetime smoking history and risk of lung cancer: results from the Framingham heart study. Journal of the National Cancer Institute. 2018; 110: 1201–1207.

[22] Soneji S, Tanner NT, Silvestri GA, Lathan CS, Black W. Racial and ethnic disparities in early-stage lung cancer survival. Chest. 2017; 152: 587–597.

[23] Jonnalagadda S, Bergamo C, Lin JJ, Lurslurchachai L, Diefenbach M, Smith C, et al. Beliefs and attitudes about lung cancer screening among smokers. Lung Cancer. 2012; 77: 526–531.

[24] Pang HH, Wang X, Stinchcombe TE, Wong ML, Cheng P, Ganti AK, et al. Enrollment trends and disparity among patients with lung cancer in national clinical trials, 1990 to 2012. Journal of Clinical Oncology. 2016; 34: 3992–3999.

[25] Cykert S. Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. JAMA. 2010; 303: 2368.

[26] Japuntich SJ, Krieger NH, Salvas AL, Carey MP. Racial disparities in lung cancer screening: an exploratory investigation. Journal of the National Medical Association. 2018; 110: 424–427.

[27] Carter-Harris L, Slaven JE, Monahan PO, Shedd-Steele R, Hanna N, Rawl SM. Understanding lung cancer screening behavior: racial, gender, and geographic differences among Indiana long-term smokers. Preventive Medicine Reports. 2018; 10: 49–54.

[28] Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: a systematic review. Research in Nursing & Health. 2017; 40: 23–42.

[29] Matthews AK, Murray M, Ben Levi J, Odell D, Jeremiah R, Moore L, et al. Preliminary evaluation of a citizen scientist educational curriculum aimed at engaging Black men in lung cancer early detection screening. American Journal of Men’s Health. 2022; 16: 155798832210994.

[30] Watson KS, Siegel LD, Henderson VA, Murray M, Chukwudozie IB, Odell D, et al. The SHARED project: a novel approach to engaging African American men to address lung cancer disparities. American Journal of Men’s Health. 2020; 14: 155798832095893.

[31] Andersen RM. National health surveys and the behavioral model of health services use. Medical Care. 2008; 46: 647–653.

[32] Matthews AK, McConnell EA, Li C, Vargas MC, King A. Design of a comparative effectiveness evaluation of a culturally tailored versus standard community-based smoking cessation treatment program for LGBT smokers. BMC Psychology. 2014; 2: 12.

[33] Kanodra NM, Pope C, Halbert CH, Silvestri GA, Rice LJ, Tanner NT. Primary care provider and patient perspectives on lung cancer screening. a qualitative study. Annals of the American Thoracic Society. 2016; 13: 1977–1982.

[34] Duong DK, Shariff-Marco S, Cheng I, Naemi H, Moy LM, Haile R, et al. Patient and primary care provider attitudes and adherence towards lung cancer screening at an academic medical center. Preventive Medicine Reports. 2017; 6: 17–22.

[35] Lau YK, Caverly TJ, Cherng ST, Cao P, West M, Arenberg D, et al. Development and validation of a personalized, web-based decision aid for lung cancer screening using mixed methods: a study protocol. JMIR Research Protocols. 2014; 3: e78.

[36] Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th edn. SAGE Publications: Thousand Oaks. 2014.

[37] Stewart D, Shamdasani P. Focus groups: theory and practice. 3rd edn. SAGE Publications: Thousand Oaks. 2015.

[38] Lathan CS, Waldman LT, Browning E, Gagne J, Emmons K. Perspectives of African Americans on lung cancer: a qualitative analysis. The Oncologist. 2015; 20: 393–399.

[39] Matthews AK, Vargas M, Kuhns L, Shappiva N, King AC. A qualitative examination of barriers and motivators to smoking cessation among HIV positive African American MSM smokers. Journal of Health Disparities Research and Practice. 2014; 7: 4.

[40] Patton M. Qualitative evaluation and research methods. 2nd edn. Sage: CA. 1990.

[41] Roberts K, Dowell A, Nie J. Attempting rigour and replicability in thematic analysis of qualitative research data; a case study of codebook development. BMC Medical Research Methodology. 2019; 19: 66.

[42] Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLOS ONE. 2020; 15: e0232076.

[43] Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014. Tobacco Control. 2016; 25: ii14–ii20.

[44] Ryan KK, Garrett-Mayer E, Alberg AJ, Cartmell KB, Carpenter MJ. Predictors of cessation pharmacotherapy use among black and non-Hispanic white smokers. Nicotine & Tobacco Research. 2011; 13: 646–652.

[45] Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults—United States, 2005–2015. Morbidity and Mortality Weekly Report. 2016; 65: 1205–1211.

[46] Trinidad DR, Pérez-Stable EJ, Emery SL, White MM, Grana RA, Messer KS. Intermittent and light daily smoking across racial/ethnic groups in the United States. Nicotine & Tobacco Research. 2009; 11: 203–210.

[47] Trinidad DR, Pérez-Stable EJ, White MM, Emery SL, Messer K. A Nationwide analysis of us racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. American Journal of Public Health. 2011; 101: 699–706.

[48] Tibuakuu M, Okunrintemi V, Jirru E, Echouffo Tcheugui JB, Orimoloye OA, Mehta PK, et al. National trends in cessation counseling, prescription medication use, and associated costs among us adult cigarette smokers. JAMA Network Open. 2019; 2: e194585.

[49] Mahabee-Gittens EM, Merianos AL, Tabangin ME, Stone L, Gordon JS, Khoury JC. Provision of free nicotine replacement therapy to parental smokers in the pediatric emergency setting. Tobacco Prevention & Cessation. 2020; 6: 30.

[50] Oudkerk M, Liu S, Heuvelmans MA, Walter JE, Field JK. Lung cancer LDCT screening and mortality reduction—evidence, pitfalls and future perspectives. Nature Reviews Clinical Oncology. 2021; 18: 135–151.

[51] Rivera MP, Katki HA, Tanner NT, Triplette M, Sakoda LC, Wiener RS, et al. Addressing disparities in lung cancer screening eligibility and healthcare access. An official American thoracic society statement. American Journal of Respiratory and Critical Care Medicine. 2020; 202: e95–e112.

[52] Jenkins WD, Matthews AK, Bailey A, Zahnd WE, Watson KS, Mueller-Luckey G, et al. Rural areas are disproportionately impacted by smoking and lung cancer. Preventive Medicine Reports. 2018; 10: 200–203.

[53] Veliz P, Matthews AK, Arslanian-Engoren C, Evans-Polce RJ, Lee JGL, Boyd CJ, et al. LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities. Cancer Epidemiology. 2019; 60: 51–54.

[54] Li C, Matthews AK, Rywant MM, Hallgren E, Shah RC. Racial disparities in eligibility for low-dose computed tomography lung cancer screening among older adults with a history of smoking. Cancer Causes & Control. 2019; 30: 235–240.

[55] Williams RM, Beck KH, Butler J, Lee S, Wang MQ, Taylor KL, et al. Lung cancer screening decisional needs among African American smokers of lower socioeconomic status. Ethnicity & Health. 2022; 27: 565–583.

[56] Tseng T, Gross T, Celestin MD, Dang W, Young L, Kao Y, et al. Knowledge and attitudes towards low dose computed tomography lung cancer screening and smoking among African Americans—a mixed method study. Translational Cancer Research. 2019; 8: S431–S442.

[57] Wang GX, Baggett TP, Pandharipande PV, Park ER, Percac-Lima S, Shepard JO, et al. Barriers to lung cancer screening engagement from the patient and provider perspective. Radiology. 2019; 290: 278–287.

[58] Martinez MC, Stults CD, Li J. Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study. BMC Primary Care. 2022; 23: 332.

[59] Muthukrishnan M, Arnold LD, James AS. Patients’ self-reported barriers to colon cancer screening in federally qualified health center settings. Preventive Medicine Reports. 2019; 15: 100896.

[60] Fiore M. Treating tobacco use and dependence: 2008 Update. Diane Publishing: Collingdale. 2008.

[61] Tindle HA, Freiberg MS, Cheng DM, Gnatienko N, Blokhina E, Yaroslavtseva T, et al. Effectiveness of varenicline and cytisine for alcohol use reduction among people with HIV and substance use. JAMA Network Open. 2022; 5: e2225129.

[62] Iaccarino JM, Duran C, Slatore CG, Wiener RS, Kathuria H. Combining smoking cessation interventions with LDCT lung cancer screening: a systematic review. Preventive Medicine. 2019; 121: 24–32.

[63] Minnix JA, Karam-Hage M, Blalock JA, Cinciripini PM. The importance of incorporating smoking cessation into lung cancer screening. Translational Lung Cancer Research. 2018; 7: 272–280.

[64] Smith SS, Fiore MC, Baker TB. Smoking cessation in smokers who smoke menthol and non-menthol cigarettes. Addiction. 2014; 109: 2107–2117.

[65] Mills SD, Hao Y, Ribisl KM, Wiesen CA, Hassmiller Lich K. The relationship between menthol cigarette use, smoking cessation, and relapse: findings from waves 1 to 4 of the population assessment of tobacco and health study. Nicotine & Tobacco Research. 2021; 23: 966–975.

[66] Smith PH, Assefa B, Kainth S, Salas-Ramirez KY, McKee SA, Giovino GA. Use of mentholated cigarettes and likelihood of smoking cessation in the United States: a meta-analysis. Nicotine & Tobacco Research. 2020; 22: 307–316.

[67] Matthews AK, Conrad M, Kuhns L, Vargas M, King AC. Project exhale: preliminary evaluation of a tailored smoking cessation treatment for HIV-positive African American smokers. AIDS Patient Care and STDs. 2013; 27: 22–32.

[68] Nierkens V, Hartman MA, Nicolaou M, Vissenberg C, Beune EJ, Hosper K, et al. Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities. A systematic review. PLOS ONE. 2013; 8: e73373.

[69] Kreuter MW, Lukwago SN, Bucholtz DC, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Education & Behavior. 2003; 30: 133–146.

[70] Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: challenges and potential solutions for underscreened groups. Preventive Medicine. 2021; 144: 106400.

[71] Kambhampati S, Ashvetiya T, Stone NJ, Blumenthal RS, Martin SS. Shared decision-making and patient empowerment in preventive cardiology. Current Cardiology Reports. 2016; 18: 49.

[72] Damman OC, Jani A, de Jong BA, Becker A, Metz MJ, de Bruijne MC, et al. The use of PROMs and shared decision‐making in medical encounters with patients: an opportunity to deliver value‐based health care to patients. Journal of Evaluation in Clinical Practice. 2020; 26: 524–540.

[73] Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Reports. 2014; 129: 19–31.

[74] Percac-Lima S, Ashburner JM, Rigotti NA, Park ER, Chang Y, Kuchukhidze S, et al. Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Cancer Medicine. 2018; 7: 894–902.

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