There is evidence that while smokers may accept the general proposition that smoking is harmful to health, they may also dismiss their own chances of being affected, reducing their intention to quit.(14,15) Australian research has shown that smokers are less likely than ex-smokers to agree that smokers have a greater risk of developing smoking related disease. Smokers are also more inclined than ex-smokers to support a range of self-exempting or cognitive dissonance reducing beliefs about smoking, such as 'Most people who quit smoking put on weight', 'Most people smoke', 'Physical activity and sport stretch the lungs and get the tar out of your system', 'It's safe to smoke low tar cigarettes', 'Most lung cancer is caused by air pollution, petrol fumes etc' and 'Many people who smoke all their lives live to a ripe old age, so smoking cannot be all that bad for you'.(15) Quitting smoking appears to involve shedding these kinds of beliefs, in addition to accepting information about the diseases caused by smoking. The authors suggest that health education campaigns could beneficially address these common kinds of misconceptions about smoking.(15)
Victorian research into beliefs of the likelihood of developing a fatal illness due to smoking showed that 7% of smokers denied that they had a chance of developing a fatal illness. These smokers were more likely to have a lesser intention to quit than smokers who acknowledged at least some disease risk.(16)
Surveys of smokers' attitudes to quitting have shown that the greatest advantages seen by smokers in quitting are feeling healthier and saving money, and that weight gain and irritability are the most frequently mentioned disadvantages.(9,17,18,19) Although the studies used in Table 12.2 and Table 12.3 are not directly comparable (the first being national, and the following series Victorian), the data have been collected by the same method, and suggest a generally more positive trend in attitudes held by smokers towards quitting, especially shown by changed perceptions of disadvantages (Table 12.2).
The national (1983) survey also asked people who had quit smoking what problems they had experienced. Overall, current smokers anticipated more potential problems with quitting than were experienced by those who had actually stopped,(17) a finding confirmed in later Victorian studies.(9,19)
Except for concern about weight gain, which was consistently mentioned more often by women, there is little difference between the sexes in perception of advantages and disadvantages of quitting. Although women are more likely to cite disadvantages to quitting than men, the percentage of women seeing 'no disadvantages' has increased over the last decade (Table 12.3). Both sexes show a trend towards lessened perceptions of disadvantages.
Victorian and South Australian research shows that, on average, smokers believe that they should quit smoking, but that they are not quite ready.(16,20,21) Applying Prochaska and DiClemente's definitions of attitudinal change leading to quitting (see Section 12.2 above), more smokers are positioned in the 'contemplation' stage than in any other category. Younger smokers and those with lighter daily consumption are more confident that they will succeed in quitting,(16,21) and those with higher educational attainment are more likely to be taking action or planning to quit than those who have not completed high school. There are no gender differences in intention to quit.(20,22)
Older smokers benefit from quitting smoking, both in terms of risk reduction for major disease, and in terms of improved general health and well-being (see Section 12.8 below). Yet evaluation of Quit campaign activities in Victoria has shown that campaigns have had less of an impact on people aged over 50 than people of other ages. People in older age groups have a lower estimation of their chances of dying from a smoking-caused illness, are less likely than younger people to be thinking about quitting, and are more likely not to have made an attempt to quit.(20,22)
Older smokers may be resistant to quitting, perhaps because they believe that having survived so far, smoking will not affect them, or conversely, that any damage is already done and that it is too late to stop. They may also represent a relatively resistant 'hard-core' group of smokers, the more motivated having already stopped.(3)
Despite typically having a more extended history of addiction, older smokers are nonetheless able to quit successfully. In a recent English study, a simple intervention based within a general practice brought about a 14% abstention rate after six months among a sample aged 60 and over.(23)
American research has found that major barriers to quitting for a population aged 50-74 were similar to those of the general smoking population noted above: concern about the process of withdrawal, the loss of a pleasure, weight gain, fear of failure, and handling boredom.(24) However the duration of smoking in older smokers may heighten these anxieties considerably, reducing self-confidence in quitting successfully. The same study reported that fewer than one-third of smokers surveyed believed that they could quit for good.
Recent Australian research has suggested that there are motivational differences for smoking between younger and older smokers. Whereas younger smokers are more likely to smoke for reasons of 'pleasurable relaxation', elderly smokers are more likely to smoke out of automatic habit, and to use it as a 'crutch' and for tension reduction.(25)
Cessation assistance for the older smoker should be tailored to assist the chronic, heavy smoker relinquish a lifetime of smoking. In addition to health information and the range of coping skills offered to the general population in prevention programs, older smokers may benefit from nicotine replacement therapy such as nicotine patches or nicotine chewing gum (providing it is not contra-indicated by medical or dental conditions). Withdrawal symptoms, especially those exacerbated by increasing years such as sleep disturbance and concentration difficulties, should be described as time limited, and older smokers reassured that 'there is life after smoking.' Alternative activities and positive reinforcers should be emphasised to offset the sense of loss and depression that may accompany quitting.(24)