First Advisor

Hyeyoung Woo

Term of Graduation

Fall 2020

Date of Publication


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Sociology






Smoking cessation, Communication in medicine, Physician and patient, Lungs -- Cancer -- Diagnosis



Physical Description

1 online resource (vii, 186 pages)


In the United States, smoking causes preventable diseases, including lung cancer, which is the leading cause of cancer deaths. Improving smoking cessation rates is important to decrease lung cancer deaths. Health care visits with a discussion about lung cancer screening (LCS) may help in increasing prevalence of smoking cessation. Importantly, insurers now require clinicians to have a shared decision-making discussion with patients that includes discussion of smoking abstinence before they can receive an LCS scan (i.e., a low-dose computed tomography scan). This discussion may represent a unique opportunity to encourage smoking cessation since it may prompt positive smoking behavior change. However, it is less known whether, and to what extent, factors are important for current smoking status or improving smoking cessation before and within the LCS decision-making discussion. This three-paper dissertation aims to understand patterns of successful smoking cessation focusing on socioeconomic, sociodemographic, and psychosocial factors among patients offered LCS at three sites: VA Portland Health Care System, VA Minneapolis Health Care System, and Duke University Medical Center. I utilize both quantitative and qualitative approaches to examine data from an existing longitudinal dataset compiled by the VA Portland Health Care System, which includes patient survey responses, electronic health records, and patient and clinician interviews. For the first paper, I describe the socioeconomic and sociodemographic factors of patients offered LCS and compare factors of those who had successfully quit smoking prior to being offered LCS with the factors of those who were not successfully able to quit. For the second paper, I examine how patient-reported presence of patient-clinician communication is associated with smoking cessation (measured at one-year follow-up). For the third paper, I qualitatively evaluate how clinicians and patients communicate about smoking in the context of the LCS decision-making discussion. With this analysis, I can explore the nuances of how patients and clinicians communicate about smoking in the context of lung cancer screening. Given that conversations between patients and clinicians pertaining to smoking may serve as a unique opportunity for smoking cessation, this dissertation provides better understandings about roles of communications with clinicians in smoking cessations among patients. First, I found that hardened smokers offered LCS differed in important social factors based on their smoking status at baseline. Second, discussing smoking cessation during the LCS decision-making discussion may not lead to successful smoking cessation at least in the short term. There may be other more important aspects that affect smoking cessation. Lastly, in support of previous findings, communication about smoking during the LCS decision-making discussion is unlikely to influence smoking behavior. Findings of the three analytic chapters can offer some insights for how the LCS decision-making discussion is helpful to encourage cessation, which would improve public health by reducing deaths from lung related diseases.


© 2020 Sara Elizabeth Golden

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This study was funded by a Research Scholar Grant, 128737-RSG-155-01-CPPB from the American Cancer Society for Christopher G. Slatore.

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