The New Your Times: Lung screening lowers the smoker’s motivation to quit smoking

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The results of a new study on smoking cessation published in New York Times suggest that the billions of dollars insurers spend on screening smokers for lung cancer could be better spent on helping them quit and keeping others from starting.

Although screening is initially seen as the first step of the whole cessation process, the new study indicates that more often smokers’ believe that they had dodged a bullet and could safely continue to smoke. Even when nodules that suggested cancer-in-the-making were found, most participants remain smokers because they believe screening could catch cancer early before it would threaten their lives.

The study was conducted by  Dr. Zeliadt, a health economist at the V.A. Puget Sound Health Care System and the University of Washington in Seattle, and seven of his colleagues and enrolled 37 current smokers who were offered lung cancer screening.

After being screened and told the results, the participants were interviewed in-depth about their smoking-related health beliefs. For about half of those in whom cancer was not found, “screening lowered their motivation for cessation”. A commonly expressed opinion was that the screening provided the same health benefits as stopping smoking, even when precancerous lung nodules were detected.

“They compared how hard it was to quit smoking with how easy it was to be screened,” said Steven B. Zeliadt, the lead author of the study. “They engaged in magical thinking that now there’s this wonderful painless external test that can save lives.” But, Dr. Zeliadt added, “If we want to save lives from smoking, we should take all this money being spent on screening and double down on smoking cessation efforts.”

The study findings shed light on a common psychological problem called cognitive dissonance – a conflict between people’s beliefs and their behaviors that typically prompts them to adjust their attitudes and beliefs to make them consistent with their behavior, rather than change their behavior, which is more challenging.

“Smoking is a classic example,” Omid Fotuhi, a social and health psychologist at Stanford University, said. “Smokers think, ‘I know smoking is unhealthy for me, but I can’t change my behavior because I’m addicted.’ So they follow the path of least resistance and keep smoking.”

Dr. Fotuhi said that counseling for smokers should target the rationalizations they use to reduce cognitive dissonance. For example, a smoker who claims that smoking helps them cope with stress should be told that the effect is only temporary and that much of the stress they experience is the result of nicotine withdrawal, which prompts them to smoke another cigarette and perpetuate the cycle. Once their system is cleared of nicotine, that stress will likely dissipate. “We need to keep our eyes focused on the prize,” he said.“On how to reduce smoking-related deaths from lung cancer and other conditions, not on how many people we can get screened.”

You can see the publication with all the information on the study here.