Perceived risk of developing lung cancer and its association with nicotine dependence and smoking behavior among adults who smoke in Golestan Province, Iran

Background Perceived risk of developing lung cancer is a critical factor influencing smoking cessation and prevention efforts. This study aimed to examine the association between nicotine dependence, stages of change in smoking behavior, and perceived risk of developing lung cancer among adults who smoke in Golestan Province, Iran.Methods A cross-sectional study was conducted with 339 adults who smoke, recruited via convenience sampling. Data were collected using self-administered questionnaires assessing demographic characteristics, smoking history, nicotine dependence (Fagerström Test for Nicotine Dependence, FTND), stages of change, and perceived developing risk of lung cancer. Pearson correlation and linear regression analyses were used to evaluate associations between variables.Results The mean (SD) age of the samples was 32.04 (12.07) with a range of 18-74 years. The mean perceived risk of developing lung cancer was 7.29 ± 4.81 (out of 20), indicating a low to moderate risk perception among participants. Nicotine dependence was positively associated with perceived risk, with each one-unit increase in FTND score corresponding to a 0.44-unit increase in perceived risk. Current adults who smoke showed a marginally higher perceived risk score compared to those reporting no smoking behavior (β = 1.57, p = 0.062). No significant associations were observed between perceived risk and age, smoking duration, or stages of change.Conclusion In this study sample, adults who smoke in Golestan Province exhibited low to moderate perceived risk of developing lung cancer. Higher nicotine dependence and current smoking status are associated with increased risk perception. These findings underscore the importance of educational and behavioral interventions aimed at raising awareness of smoking-related health risks and reducing nicotine dependence. Future studies with larger, representative samples and longitudinal designs are recommended to further explore causal relationships and inform targeted public health strategies.