Sure, Smoking Causes Cancer, But It Won't Happen to Me
The University of Pennsylvania's Annenberg School for Communication conducted a national telephone survey that assessed how well adolescents understand the risks of smoking. Working under the direction of the Annenberg Public Policy Center (APPC), Princeton Survey Research Associates surveyed 300 smokers and 300 nonsmokers aged 14 to 22.
The survey found that:
- Although young people do tend to overstate one of the best-known smoking-related risks that of contracting lung cancer they either underestimate or do not know of the danger of several other serious risks. These include:
- The chance of dying from lung cancer after contracting the disease.
- The overall risk of dying from smoking-related illnesses.
- The average years of life lost to smoking-related illnesses.
- Their own personal risk as opposed to the risk to smokers in general.
- The dangers of smoking in comparison to other kinds of high-risk behavior, such as the use of illegal drugs.
- They are also overly optimistic about their ability to quit smoking when they wish. Smokers who saw smoking as very risky were more than four times more likely to want to quit than others suggesting that smoking-cessation campaigns should emphasize the risks of smoking.
- Concern about second-hand smoke appears to motivate quitting and suggests that campaigns should also include education about the dangers of secondhand smoke and the rights of nonsmokers.
Researchers presented their preliminary findings at a July 1999 seminar at the Annenberg School and have written two articles and three chapters for a book on smoking risk (see the Bibliography).
The Annenberg Public Policy Center conducted a second survey that extended the findings to adults. The results of both surveys are contained in five chapters in a book edited by Paul Slovic, Smoking: Risk, Perception, and Policy (Sage Press, 2001).
The Robert Wood Johnson Foundation (RWJF) provided a $40,000 grant for the project.
According to a 1994 surgeon general's report, most people who smoke began before the age of 20. Adolescent smoking has been a matter of concern because an estimated one-third of those who smoke as teenagers will die of smoking-related causes if they continue to smoke at the same rates as previous generations. Health experts estimate that 50 percent of lifetime smokers will die prematurely from the habit. Half of those deaths will result from lung cancer, which has approximately an 80 percent fatality rate.
Observers have disagreed about the ability of adolescents to appreciate the health risks of smoking. Risk economist W. Kip Viscusi analyzed a 1985 nationwide telephone survey sponsored by the tobacco industry. The survey comprised 3,100 respondents, of whom 300 were young people aged 16 to 21. Based on that survey, Viscusi claimed that adolescents understand the risks of smoking and even exaggerate the risk of developing lung cancer.
With funding from RWJF, APPC part of the Annenberg School for Communication at the University of Pennsylvania conducted a survey of adolescents to investigate how well adolescents understand the risks of cigarettes. From May to July 1999, Princeton Survey Research Associates conducted the National Smoking Risk Assessment Survey of 300 smokers and 300 nonsmokers aged 14 to 22.
The survey used some of Viscusi's questions for eliciting risk judgments about smoking, but probed further to assess perceptions of health risks to the respondent as well as to smokers in general. The survey also investigated respondents' knowledge about how the severity of smoking-related risk compares with other kinds of behavior-related risks. Respondents were asked their perceptions of such other risks as harming others through secondhand smoke and the potential benefits of smoking, such as weight control. The survey also asked about intentions to quit smoking and how easy or difficult respondents felt it would be to do so.
- Only 28 percent of smokers and 35 percent of nonsmokers accurately assessed the risk of lifetime smoking. Young people do not overestimate the overall mortality rate. Only 27 percent of smokers and 31 percent of nonsmokers overestimated the risk of premature death from lifetime smoking, which health experts set at 50 percent. Some 46 percent of smokers and 34 percent of nonsmokers either underestimated the true mortality rate of lifetime smoking or indicated they did not know what the rate was.
- Young people do overstate the risk of contracting lung cancer as a result of smoking, but underestimate the deadliness of this disease. Some 64 percent of young smokers and 74 percent of nonsmokers overstated the risk of contracting lung cancer from lifetime smoking in comparison to epidemiological estimates. Respondents underestimated, however, how likely lung cancer is to be fatal.
- Young smokers understand that smoking is likely to shorten a person's life, but do not have a clear idea of the number of years involved. More than two-thirds of smokers (68 percent) said that smoking two or more packs per week would shorten one's life, but less than half knew the time lost would be as long as 5 to 10 years. About one in seven thought a year or less would be lost, and about one in four could not say how many years might be lost.
- Young smokers are optimistic that they personally will avoid the health consequences of smoking. In keeping with other research findings, young smokers in this study estimated their own personal risks differently from risks to smokers in general. Regardless of their view of general risk, large proportions of young smokers viewed their own smoking as less than "very risky" for their health. Some 40 percent of young smokers who knew that about half of lifetime smokers die from smoking-related causes nonetheless viewed their own smoking as less than very risky.
- The perception of risk affects a smoker's desire to quit. About four in five smokers reported that they planned to quit. Those who saw smoking as very risky were more than four times more likely to want to quit than others were. This finding suggests that antismoking campaigns aimed at adolescents should emphasize risks.
- Young people say smoking is less likely to kill than other causes of death that may be behavior related. Some 42 percent of respondents did not know that more people die from smoking-related causes than from gunshots and car accidents combined, while 63 percent did not know that more die from smoking than drug abuse.
- Concern about secondhand smoke can motivate young people to quit smoking. The only statistically significant predictor of planning to quit smoking or having actually quit was the belief that secondhand smoke harmed nonsmokers. A respondent who expressed this concern was three times as likely to have quit or to report planning to do so as was a smoker who did not believe secondhand smoke was harmful. This finding suggests adolescent antismoking campaigns should educate teens about the dangers of secondhand smoke and the rights of nonsmokers.
Researchers presented preliminary findings of the survey at the Seminar on Adolescent Risk Perception about Health-Related Activities, which was held at APPC on July 12, 1999. Two research articles have been published in health journals. These chapters in a newly published book Smoking: Risk, Perception, and Policy contain information from the survey. The dataset has been deposited with the University of Michigan Survey Research Archive. (See the Bibliography for details.)
AFTER THE GRANT
APPC plans to conduct further surveys that will examine changes in perceptions of risk and attitudes toward smoking. Those surveys will build on the findings of the survey described earlier to increase understanding of how youth and adults perceive the risks of smoking and the consequences of failing to grasp the risks before they start smoking.
GRANT DETAILS & CONTACT INFORMATION
Study of Teen Risk Perception of Smoking
University of Pennsylvania, The Annenberg School for Communications (Philadelphia, PA)
Dates: August 1999 to February 2000
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Jamieson PE and Romer D. "What Do Young People Think They Know about the Risks of Smoking?" In Smoking: Risk, Perception, and Policy, Paul Slovic (ed.). Thousand Oaks, Calif.: Sage Publications, 2001.
Jamieson PE and Romer D. "A Profile of Smokers and Smoking," in Smoking: Risk, Perception, and Policy, Paul Slovic (ed.). Thousand Oaks, Calif.: Sage Publications, 2001.
Jamieson PE and Romer D. "The Catch 22 of Smoking and Quitting." In Smoking: Risk, Perception, and Policy, Paul Slovic (ed.). Thousand Oaks, Calif.: Sage Publications, 2001.
Glantz SA and Jamieson PE. "Attitudes Toward Secondhand Smoking, Smoking, and Quitting Among Young People." Pediatrics, 106(6): E82, 2000. Abstract available online.
Romer D and Jamieson P. "Do Adolescents Appreciate the Risks of Smoking? Evidence from a National Survey." Journal of Adolescent Health, 29(1): 1221, 2001. Abstract available online.
Presentations and Testimony
Jamieson PE and Romer D. "Report on Survey of Risk Perceptions of 200 Adolescent Smokers and 200 Adolescent Non-Smokers." Seminar on Adolescent Risk Perception about Health-Related Activities, at the Annenberg Public Policy Center, Annenberg School for Communication, University of Pennsylvania, July 12, 1999.
"Annenberg Tobacco Risk Study, 1999" US (#3049). Deposited with the Health and Medical Archive of the Interuniversity Consortium of Political and Social Research at the University of Michigan.
Report prepared by: Susan Freis
Reviewed by: Robert Narus
Reviewed by: Janet Heroux
Program Officer: Frank Karel