Exploring the association between perceived risks of smoking and benefits to quitting: Who does not see the link?
Introduction
Cigarette smoking is the leading preventable cause of death in the United States and is forecasted to be an ongoing public health problem. Following two decades of decline, rates of smoking have remained relatively stable, hovering around 25% for the past 10 years. National surveys indicate that 70% or more of smokers report that smoking is hazardous to health and some reports suggest that smokers even overestimate the health risks of smoking (Viscusi, 1990). Smokers cite concerns about the harms of smoking as primary motivators for them to consider cessation Duncan et al., 1992, Halpern & Warner, 1993. Yet, many continue to smoke despite these concerns. How is it that smokers can be aware of the substantial harms to smoking and yet continue to smoke? This apparent discordance in awareness and behavior is of particular concern because the harms of smoking and benefits of quitting are a major motivational focus of most smoking cessation programs. Thus, a better understanding of this discordance could be informative for improving cessation interventions.
Popular conceptual models (Strecher & Rosenstock, 1997) suggest a cascade of factors that influence smoking cessation. Generally, these models posit that for smoking cessation to occur, an individual must perceive personal vulnerability to related negative outcomes Bandura, 1977, Janz & Becker, 1984, Rosenstock, 1974, must see the outcomes as severe, and believe that quitting smoking will reduce the likelihood of their occurrence. Further, it has been argued that concepts of perceived vulnerability to health effects, and severity of risk are relatively complex domains (Weinstein, 1998). For example, perceptions of risk can vary based on whether one is comparing oneself to a specific reference group (e.g., similar in age, race, or smoking status), the time frame that is being considered (lifetime, 10 years, etc.), and conditional on whether one quits or continues to smoke Klein & Weinstein, 1997, Ronis, 1992, Weinstein, 1980, Weinstein & Klein, 1995. Thus, it has been argued that smokers may acknowledge risks of smoking to generalized others, yet at the same time not fully acknowledge their own personal vulnerability to these risks Rothman et al., 1996, Strecher et al., 1995, Weinstein, 1988. The majority of these studies have focused on the accuracy of smokers' risk perceptions rather than the extent to which these perceptions vary with demographic and other smoking-related characteristics. Consideration of the characteristics of smokers who do and do not see the link between their smoking and potential health harms could be informative in guiding the development of effective smoking cessation programs. For example, if a light smoker perceives less harm to smoking and in turn, fewer benefits to quitting, regardless of the reference group than a heavier smoker, then health messages for this population may be best focused on countering these misperceptions. In turn, heavier smokers who may see great harm to smoking but few benefits to quitting may benefit from more optimistic representations of the benefits of smoking cessation. Thus, understanding the multidimensionality of the link between perceived risks and benefits and how these vary among subgroups of smokers could influence how risk messages are communicated to smokers.
Smokers' perceived benefits of smoking cessation also may be influenced by other factors such as their level of concern or worry about smoking-related health outcomes and their confidence that they could quit if they tried. For example, the Health Belief and other models Bandura, 1977, Strecher & Rosenstock, 1997 would suggest that perceived risks and benefits might be most strongly associated among those who are especially concerned about suffering the health effects of smoking than among those who are relatively unconcerned. Exploring conceptually meaningful associations among subgroups of smokers could give greater insight to the development of motivational interventions for smokers.
To date, few studies have included the broad array of measures of perceived risks, benefits, and related concerns that are needed to better understand possible interrelationships. With the above in mind, this report asked two questions. First, is there an association between comparative and conditional risk for lung cancer and perceived benefits of quitting smoking for reducing these risks? We hypothesized that higher perceived risk regardless of the conditional comparison would be associated with greater perceived benefits to quitting. The second question asked, whether associations among risk perceptions and perceived benefits of quitting were influenced by demographics, smoking patterns, motivation, and self-efficacy for cessation or concerns related to the disease outcome? We hypothesized that associations among perceived risks and benefits would be greatest among smokers who were most concerned about health effects, and those who were most motivated and most confident they could quit.
Section snippets
Study recruitment
As part of a pilot study conducted in preparation for a randomized intervention trial, smokers were recruited via newspaper and public service radio advertisements and recruitment tables located at various community and medical center locations. A detailed description of the pilot study is provided elsewhere (McBride et al., 2000). Study advertisements stated that smokers were being recruited to evaluate a “new test for smokers” and stated specifically that participants would not be asked to
Sample description
Three hundred and nine smokers called the RCL and completed the telephone screener. Forty-eight were ineligible, nine did not smoke enough, six had participated in a previous study, one was pregnant, and 32 were receiving care at the planned trial site. Of the 261 eligible participants, 17 declined to participate at screening, and 100 eligible smokers who agreed to participate did not keep their appointment at the RCL; 144 smokers participated in the study.
Overall, the participants were
Discussion
Consistent with a large literature, smokers in this study were aware of health risks and for the most part rated their risks to be higher than nonsmokers. In addition, a majority of smokers acknowledged that quitting would reduce their chances of getting lung cancer. However, the picture becomes far more complicated when associations between these perceptions are explored further. Smokers who perceive negative health effects of smoking may not necessarily see related benefits to quitting and
Acknowledgements
This work was supported by a grant from the National Cancer Institute (CA72099 and CA76945), Biomarker and Partner. In addition, the authors would like to acknowledge the contributions of Dr. Bercedis Peterson for help with statistical analyses.
References (22)
- et al.
Reasons for quitting: intrinsic and extrinsic motivation for smoking cessation in a population-based sample of smokers
Addictive Behaviors
(1997) - et al.
Motivations for smoking cessation: a comparison of successful quitters and failures
Journal of Substance Abuse
(1993) Social learning theory
(1977)- et al.
A randomized trial of self-help materials, personalized feedback, and telephone counseling with nonvolunteer smokers
Journal of Consulting and Clinical Psychology
(1995) - et al.
Intrinsic and extrinsic motivation for smoking cessation
Journal for Consulting and Clinical Psychology
(1990) - et al.
Quitting smoking: reasons for quitting and predictors of cessation among medical patients
Journal of General Internal Medicine
(1992) - et al.
The health belief model a decade later
Health Education Quarterly
(1984) - et al.
Social comparison and unrealistic optimism about personal risk
- et al.
One size does not fit all: the case for tailoring print materials
Annals of Behavioral Medicine
(1999) - et al.
Maximizing the motivational impact of feedback of lung cancer susceptibility on smokers desire to quit
Journal of Health Communications
(2000)
Quitting motives and barriers among older smokers. The 1986 adult use of tobacco survey revisited
Cancer
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