Identifying smoker subgroups with low readiness to quit: a cluster analysis of perceived lung cancer and asthma risk profiles

BACKGROUND: Perceived disease risk is a key determinant of smoking cessation, yet many smokers underestimate their personal vulnerability to smoking-related diseases. This study identified distinct risk-perception profiles for lung cancer and asthma among smokers and examined their associations with sociodemographic factors, nicotine dependence, and readiness to quit. METHODS: A cross-sectional study was conducted among 310 adult cigarette smokers in Khuzestan Province, Iran (January-September 2024). Perceived susceptibility and perceived severity of lung cancer and asthma, nicotine dependence, and stage of change (readiness to quit) were assessed using validated instruments. Hierarchical cluster analysis (Ward's method, Euclidean distance) was used to identify risk-perception profiles. Associations between clusters and participant characteristics were examined using Chi-square and Kruskal-Wallis tests. Multinomial logistic regression was fitted to identify independent predictors of cluster membership. RESULTS: Four distinct risk-perception profiles emerged for both diseases: Indifferent (low susceptibility/low severity), Optimistic Bias (low susceptibility/high severity), Dismissive (high susceptibility/low severity), and Concerned (high susceptibility/high severity). In adjusted analyses, the Indifferent cluster was independently characterized by low nicotine dependence, whereas the Concerned cluster combined high dependence with greater readiness to quit. In the asthma model, the Optimistic Bias cluster-despite low perceived personal susceptibility-displayed the most favorable quit readiness profile, including the highest proportion planning to quit within one month. Male gender independently predicted the Optimistic Bias cluster, and higher income reduced its likelihood in the asthma model; for lung cancer, low income and moderate or high nicotine dependence were significant independent predictors. CONCLUSION: Smokers exhibit heterogeneous risk-perception profiles that are distinctly linked to nicotine dependence and quit readiness. The finding that the Indifferent profile is marked by low rather than high dependence suggests that lack of risk perception in this group stems from other cognitive or socioeconomic barriers beyond addiction. Tailored interventions should move beyond generic risk messages: for Indifferent smokers, addressing underlying barriers to risk acknowledgment; for Optimistic Bias smokers, leveraging their high perceived severity; and for Concerned smokers, coupling cessation support with dependence treatment.