3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

Show / hide chapter menu

3.0 Background

3.1 Tobacco—a leading preventable cause of death and disease

3.2 Cardiovascular diseases

3.3 Lung cancer

3.4 Respiratory diseases

3.5 Other cancers caused by or associated with smoking

3.6 Reproductive health and smoking

3.7 Pregnancy and smoking

3.8 Infant health and smoking

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastrointestinal diseases

3.13 Bone density and risk of fractures

3.14 Effects of smoking on the skin

3.15 Smoking and complications in medical treatment

3.16 Smoking and diabetes

3.17 Poorer levels of general health

3.18 Smoking, motor vehicle crashes and other injuries

3.19 Burns and fires caused by tobacco use

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Genetic influences on tobacco-caused disease

3.23 Smoking, dementia and cognitive decline

3.24 Lung disease, smoking and occupational exposures

3.25 Air pollution, cigarette smoking and ill health

3.26 Health effects of smoking brands that claim to deliver lower levels of tar, nicotine and carbon monoxide

3.27 Health effects of smoking tobacco in other forms

3.28 Health 'benefits' of smoking?

3.29 Morbidity (ill health) attributable to tobacco-caused disease

3.30 Deaths attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socioeconomic disadvantage

3.32 Health effects of smoking other substances

3.33 Health effects of chewing tobacco, and of other smokeless tobacco products

3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

3.35 Health benefits of cessation

3.36 The global tobacco pandemic

Acknowledgments

References

3.34.1 Australian attitudes to tobacco as a drug

Findings from the 2004 National Drug Strategy Household Survey show that almost half of adult Australians (aged 14 and over) correctly nominate tobacco as the greatest cause of drug deaths, followed by alcohol and illicit drugs (Table 3.8).148

However, tobacco does not rank highly as 'the drug thought to be of most serious concern for the community,' presumably reflecting the greater social disruption caused by alcohol and illegal drugs (Table 3.9).148

Again, presumably reflecting the social disruption caused by other drug use, tobacco is not a drug most likely to be associated with a 'drug problem' by most people (Table 3.10).148

Of all drugs used in Australia, alcohol has the greatest degree of personal approval, followed by tobacco and marijuana (Table 3.11). This reflects patterns of drug usage in the community (see Table 1.10 in Chapter 1). Not surprisingly, individuals who have used a particular drug recently are more likely to approve of its regular usage than those who have not used the drug in the preceding year. In the case of tobacco, more than 80% of recent users approve of its use, compared with fewer than 30% of non-users.148

3.34.2 Awareness among smokers and recent quitters of damage to health caused by smoking

Most Australian smokers agree that smoking causes disease. As part of the International Tobacco Control Four Country Survey (ITC-4) in 2002,235 a representative sample of Australian smokers was asked whether smoking causes lung cancer, heart disease, stroke and impotence (Table 3.12).

Overall, of the four diseases mentioned, smokers had the highest awareness of lung cancer, followed by heart disease, stroke and impotence. Smokers with higher education and income levels tended to have a greater degree of knowledge than other smokers. Although it is widely accepted that smoking causes lung cancer, it is of concern that about 20% of smokers do not believe tobacco use causes stroke, and 10% do not think that smoking causes heart disease. Canadian smokers demonstrated the overall highest awareness of the health risks of smoking, ahead of smokers in Australia, the United Kingdom and the United States of America.235

As part of ongoing evaluation of the National Tobacco Campaign staged between June 1997 and December 2000, a series of national annual surveys of public awareness about the health consequences of smoking have been undertaken.236 Because the target group for the campaign was smokers aged between 18 and 40 years, the survey group studied falls within this age range. The findings reported in the tables below do not, therefore, represent the whole population. However, there is strong evidence that the advertising and promotion associated with National Tobacco Campaign has had an impact on people aged under 18,237 and it is highly probable that population groups aged over 40 were also educated and influenced by the campaign to some extent.[12]

Survey respondents in each year were asked whether, in their opinion, there were any illnesses caused by smoking (Table 3.13). If they thought that smoking did cause illness, they were asked to name the diseases. In every survey year, about 95% of respondents believed that smoking caused illness or damage to health. Highest awareness was of lung damage (especially lung cancer) and arterial illness or damage. Four out of five smokers or recent quitters spontaneously nominated smoking as a cause of lung illness or damage, and between a quarter and a third of smokers stated that smoking was a cause of arterial illness or damage. Nomination of particular disease entities varied for some of the years, probably due to timing of various campaign initiatives.236

Respondents were also asked whether or not they agreed or disagreed with particular statements made about smoking (Table 3.14). Compared to the previous table, which shows unprompted awareness, not surprisingly prompted awareness was much higher. About 90% of smokers and recent quitters agreed that smoking causes lung cancer, and almost as many smokers were aware that smoking causes emphysema. Agreement with statements regarding heart disease and environmental tobacco smoke increased significantly over the survey period. Statements were also offered for smokers and recent quitters to express disagreement with. Over the time period surveyed, smokers and recent quitters became significantly less likely to disagree with the notion that the health dangers of smoking have been exaggerated.236 Respondents were also more likely to resist key myths about smoking over the years surveyed. Increasing numbers of smokers and recent quitters expressed disagreement with the statements that 'smoking can't be all that bad because many people smoke all their lives and live to a ripe old age,' and 'smoking the occasional cigarette does not cause any damage to your health.'236

Smokers were also asked whether or not they thought they were likely to become ill from smoking if they continue to smoke. Both smokers and recent quitters were asked whether they thought they had already sustained some harm from smoking. Over the survey period, smokers became significantly more likely to agree that smoking would make them ill, and more than half of smokers and recent quitters felt that their health had already been damaged by smoking (Table 3.15)236.

A realistic appreciation of the health risk posed by smoking to the individual helps to shape attitudes to quitting. Smokers who have an unrealistic optimism about their personal risk of avoiding illness from smoking are less likely to quit smoking.238 Attitudes to smoking are further explored in Chapters 5 and 7.