7.5 What we know about how smokers are persuaded to attempt to quit

Last updated: January 2023

Suggested citation: Jenkins, S., Greenhalgh, EM., & Ford, C. 7.5 What we know about how smokers are persuaded to attempt to quit. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2023. Available from http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-5-what-we-know-about-smokers-who-are-persuaded 


While the majority of smokers regret ever trying smoking,1-3 indicating an underlying desire to quit,4 the highly addictive nature of smoking means that a persons’ motivation to quit can fluctuate as a person’s negative thoughts about smoking compete with their dependence on nicotine and a range of environmental and biopsychosocial factors that can promote smoking (see Section 7.7 ). As such, reaching the point of making and sustaining a quit attempt can be a challenge. Smokers may also believe that a rational, unambivalent desire to quit is needed before it is worthwhile trying, and that short-term impulses to act are not sufficient.4 Helping smokers to overcome their ambivalence about quitting is crucial to increasing quit attempts.

7.5.1 Personalisation of risk

Studies of smokers’ risk perceptions have generally found that many are unrealistically optimistic about their personal health risks. 5,6 Smokers show a clear tendency to believe that they are at lesser risk than other smokers of becoming addicted or suffering health effects.5,7,8 One study found that those who perceived their own risk of developing lung cancer to be less than the actual risk were more likely to accept myths associated with smoking, overestimate the number of lung cancers that are cured, and be less likely to quit.9 While the risk of lung cancer and other smoking-related diseases are acknowledged by smokers, they often judge the size of these risks to be smaller and less well established than do non-smokers or than scientific evidence would justify. 5,7 Smokers also estimate that the health consequences of smoking occur much later in life than non-smokers do.10 A US study of smokers found that those who never plan to quit are more likely deny or doubt that smoking causes disease or death.11

Correcting unrealistic judgements about risk may facilitate increased quitting.12 For example, providing adults with an estimation of their risk of global coronary heart disease can improve the accuracy of their risk perception and may increase the intention of those at medium to high risk to initiate preventative actions such as quitting smoking.13 There is some evidence that encouraging smokers to think and worry more about their smoking behaviour, rather than focusing on their beliefs about the risks involved, encourages them to try to quit.14 A study that presented participants with a simulated and personalised experience of a heart attack combined with motivational interviewing found that more than half of participants were abstinent at six months.15

Another strategy that has been suggested for increasing smoking cessation rates is to provide smokers who have contact with healthcare systems feedback on the biomedical or potential future effects of smoking. However, a 2019 Cochrane review found little evidence that feedback on the physical effects of smoking using physiological measurements (for example, exhaled carbon monoxide measurement or lung function tests) aids in long-term quitting16 and subsequent research has produced mixed findings.17-20 Section 7.18.4 provides a more detailed overview of biofeedback methods for smoking cessation and their effectiveness.

7.5.2 Addressing risk-minimising and self-exempting beliefs

According to cognitive dissonance theory, people seek consistency among their beliefs, attitudes, and behaviours. When there is inconsistency (dissonance), people experience discomfort, and attempt to resolve it through changing or rationalising their thoughts and/or actions.23 Smokers widely accept that smoking is bad for them, yet continue to do it. A high proportion of smokers hold various beliefs that serve to minimise the reality of the harms caused by smoking or rationalise their behaviour, and allow them to avoid engaging in the task of quitting.12,24-27 For example, there is evidence that use of dietary supplements may create perceptions of invulnerability in smokers and discourage changes in their smoking behaviour.28

Four categories of these beliefs have been identified:24

  • Sceptic beliefs indicate smokers do not believe the evidence about the health effects of smoking : ‘Lots of doctors and nurses smoke, so it cannot be all that harmful’, ‘More lung cancer is caused by such things as air pollution, petrol and diesel fumes than smoking’.
  • Bulletproof beliefs allow smokers to think that they are personally immune to smoking-related illness : ‘You can overcome the harms of smoking by doing things like eating healthy food and exercising regularly’, ‘I think I would have to smoke a lot more than I do to put my health at risk’.
  • ‘Worth it’ beliefs suggest the benefits of smoking outweigh the risks : ‘You have got to die of something, so why not enjoy yourself and smoke’, ‘I would rather live a shorter life and enjoy it than a longer one where I would be deprived of the pleasure of smoking’.
  • Jungle (i.e., normalising) beliefs normalise the risks of smoking : ‘Everything causes cancer these days’, ‘It is dangerous to walk across the street’.

Australian research found that each of the four sets of risk-minimising and self-exempting beliefs was inversely related to intention to quit, however some were more important than others. ‘Worth it’ beliefs in particular were more prevalent among smokers not planning to quit. Higher knowledge of the hazards of smoking and being able to recall at least one anti-smoking commercial was linked to holding fewer such beliefs.24

Subsequent research in the USA, Canada, UK, and Australia found that after controlling for demographic factors, the risk-minimising beliefs (’sceptic’, ‘worth it’, and ‘jungle’ beliefs) predicted lower quit intentions and attempts among smokers, but the self-exempting belief (‘bulletproof’ belief) did not. The authors conclude that countering risk-minimising beliefs may facilitate increased quitting, but this may not be so important for self-exempting beliefs.12

A survey of socioeconomically disadvantaged smokers in New South Wales (NSW) found many endorsed risk-minimising and self-exempting beliefs in relation to smoking, particularly ‘jungle’ and ‘sceptic’ beliefs. Though only ‘sceptic’ beliefs were associated lower quit intentions, after controlling for other smoking-related factors.29

Australian research has also indicated that smokers who placed greater importance on their own experiences rather than external sources of cessation advice (e.g., evidence-based sources or alternatives) were less likely to be concerned about the health effects of smoking and were more likely to believe that the harms of smoking are exaggerated. Smokers who considered all sources of advice about smoking to be unimportant were more likely to endorse ‘jungle’ beliefs and were less likely to be concerned about the health effects of smoking.30

Creative interventions and campaigns that address the risk-minimising and self-exempting beliefs held by smokers may assist in motivating more ambivalent smokers. Researchers suggest using messages that emphasise the relative risks of smoking, the reduced quality of life associated with smoking-related diseases and the risks of premature death.24  

7.5.3 The role of media in promoting thoughts about quitting

The level of media attention that a particular issue receives can affect how important the issue is perceived to be, and the extent to which it is prioritised. For example, a greater volume of news coverage has been linked to increased contraceptive use31 and breast screening.32 Research in NSW found that high levels of self-reported exposure to tobacco news were associated with important smoking-related cognitions, including beliefs about harm from smoking and frequent thoughts about quitting. The authors highlight that the media are an important source of information for smokers, and can put or keep quitting on the smokers’ agenda.33 A survey of  Aboriginal and Torres Strait Islander people who smoke found self-reported noticing of anti-tobacco news stories in the past six months was associated with significantly higher levels of worry about the dangers of smoking to individual health and desire to quit smoking.2 US research has also found that following the news coverage of lung cancer diagnoses or deaths of high-profile individuals, which often included mention of smoking as a risk factor for lung cancer, attitudes toward lung cancer were less fatalistic and a sustained increase in quitline calls was observed.34 Media attention about the risks of smoking on SARS-CoV-2 virus (COVID-19) susceptibility and survival may have affected quitting intention and behaviour over the COVID-19 pandemic—see Section 7.7.3.

Section 14.6 provides further detail on news media coverage of tobacco issues.

Media coverage of the implementation of new health warnings on cigarette packs can stimulate discussions in social settings, and talking with family and friends about health warnings is an independent predictor of subsequent quit attempts.36 See Section 12A.3 for further detail on the efficacy of health warnings for promoting quitting intentions and behaviours. Additional population-wide strategies that are known to increase quitting activity include price increases  (see Section 13.5) and public education campaigns (see Section 14.4). Campaigns can influence individual decision-making about quitting as smokers view or hear campaign messages directly and reflect on their own lives, as well as prompt discussions about tobacco use within family and friendship networks.39


Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated March 2024)



1. Fong G, Hammond D, Laux F, Zanna M, Cummings K, et al. The near-universal experience of regret among smokers in four countries: findings from the International Tobacco Control Policy Evaluation Survey. Nicotine and Tobacco Research, 2004; 6(suppl 3):S341–S51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15799597

2. Nicholson AK, Borland R, Sarin J, Wallace S, van der Sterren AE, et al. Recall of anti-tobacco advertising and information, warning labels and news stories in a national sample of Aboriginal and Torres Strait Islander smokers. Medical Journal of Australia, 2015; 202(10):S67-72.

3. Sansone N, Fong GT, Lee WB, Laux FL, Sirirassamee B, et al. Comparing the experience of regret and its predictors among smokers in four Asian countries: findings from the ITC surveys in Thailand, South Korea, Malaysia, and China. Nicotine and Tobacco Research, 2013; 15(10):1663-72. Available from: https://doi.org/10.1093/ntr/ntt032

4. Balmford J and Borland R. What does it mean to want to quit? Drug and Alcohol Review, 2008; 27(1):21–7. Available from: https://pubmed.ncbi.nlm.nih.gov/18034378/

5. Weinstein N. Accuracy of smokers' risk perception. Nicotine and Tobacco Research, 1999; 1(suppl. 1):S123–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11184311

6. Helweg-Larsen M and Nielsen G. Smoking cross-culturally: risk perceptions among young adults in Denmark and the United States. Psychology & Health, 2009; 24(1):81–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20186641

7. Weinstein N. Accuracy of smokers' risk perceptions. Annals of Behavioral Medicine, 1998; 20(2):135–40. Available from: www.ncbi.nlm.nih.gov/pubmed/9989319

8. Weinstein N, Marcus S, and Moser R. Smokers’ unrealistic optimism about their risk. Tobacco Control, 2005; 14(1):55–9. Available from: http://tobaccocontrol.bmj.com/content/14/1/55.abstract

9. Dillard A, McCaul K, and Klein W. Unrealistic optimism in smokers: implications for smoking myth endorsement and self-protective motivation. Journal of Health Communication, 2006; 11(Suppl 1):93–102. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16641076

10. Pancani L and Rusconi P. The onset time delaying effect: smokers vs non-smokers place the adverse consequences of smoking further in the future. Journal of Cognitive Psychology, 2018; 30(3):257-69. Available from: https://doi.org/10.1080/20445911.2017.1415346

11. Popova L, Majeed B, Owusu D, Spears CA, and Ashley DL. Who are the smokers who never plan to quit and what do they think about the risks of using tobacco products? Addictive Behaviors, 2018; 87:62-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29958136

12. Borland R, Yong H, Balmford J, Fong G, Zanna M, et al. Do risk-minimizing beliefs about smoking inhibit quitting? Findings from the International Tobacco Control (ITC) Four-Country Survey. Preventive Medicine, 2009; 49(2–3):219–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19573553

13. Sheridan S, Viera A, Krantz M, Ice C, Steinman L, et al. The effect of giving global coronary risk information to adults: a systematic review. Archives of Internal Medicine, 2010; 170(3):230–9. Available from: http://archinte.ama-assn.org/cgi/content/full/170/3/230

14. Magnan R, Koblitz A, Zielke D, and McCaul K. The effects of warning smokers on perceived risk, worry, and motivation to quit. Annals of Behavioral Medicine, 2009; 37(1):46–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19255818

15. May R, Tofler GH, Bartrop R, Heinrich P, Baird J, et al. Smoking cessation through a novel behavior modification technique. The American Journal of Cardiology, 2010; 106(1):44–6. Available from: http://www.sciencedirect.com/science/journal/00029149

16. Clair C, Mueller Y, Livingstone‐Banks J, Burnand B, Camain JY, et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews, 2019; (3). Available from: https://doi.org//10.1002/14651858.CD004705.pub5

17. Clergue-Duval V, Lair R, Lefebvre-Durel C, Barre T, Gautron MA, et al. COPD Positive Screening with Spirometry Increases Motivation to Quit Tobacco Smoking in an Addiction Treatment Center. COPD, 2020:1-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32336146

18. Ronaldson SJ, Dyson L, Clark L, Hewitt CE, Torgerson DJ, et al. The impact of lung function case-finding tests on smoking behaviour: A nested randomised trial within a case-finding cohort. Health Sci Rep, 2018; 1(6):e41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30623078

19. Westerdahl E, Engman KO, Arne M, and Larsson M. Spirometry to increase smoking cessation rate: A systematic review. Tob Induc Dis, 2019; 17:31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31516474

20. Ben Fredj M, Garrach B, Bennasrallah C, Migaou A, Abroug H, et al. Spirometry as a motivator for smoking cessation among patients attending the smoking cessation clinic of Monastir. BMC Public Health, 2022; 22(1):1164. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35689178

21. Bize R, Burnand B, Mueller Y, Rège-Walther M, Camain J-Y, et al. Biomedical risk assessment as an aid for smoking cessation. The Cochrane Library, 2012. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004705.pub4/full

22. Foulds J, Veldheer S, Hrabovsky S, Yingst J, Sciamanna C, et al. The effect of motivational lung age feedback on short-term quit rates in smokers seeking intensive group treatment: A randomized controlled pilot study. Drug and Alcohol Dependence, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26051163

23. Festinger L, A theory of cognitive dissonance. London: Tavistock; 1962.

24. Oakes W, Chapman S, Borland R, Balmford J, and Trotter L. "Bulletproof skeptics in life's jungle": which self-exempting beliefs about smoking most predict lack of progression towards quitting? Preventive Medicine, 2004; 39(4):776–82. Available from: www.ncbi.nlm.nih.gov/pubmed/15351545

25. Brennan E. Smokers’ self-exempting beliefs: findings from the 2006 Victorian Population Survey. Melbourne: Centre for Behavioural Research in Cancer, 2007.

26. Radtke T, Scholz U, Keller R, and Hornung R. Smoking is ok as long as I eat healthily: Compensatory Health Beliefs and their role for intentions and smoking within the Health Action Process Approach. Psychology & Health, 2011; 27 Suppl 2:91–107. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21812704

27. Fotuhi O, Fong GT, Zanna MP, Borland R, Yong H-H, et al. Patterns of cognitive dissonance-reducing beliefs among smokers: a longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 2013; 22(1):52–8. Available from: http://tobaccocontrol.bmj.com/content/22/1/52.abstract

28. Chiou W, Wan C, Wu W, and Lee K. A randomized experiment to examine unintended consequences of dietary supplement use among daily smokers: taking supplements reduces self-regulation of smoking. Addiction, 2011; 106(12):2221–8. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03545.x/full

29. Guillaumier A, Bonevski B, Paul C, D'Este C, Twyman L, et al. Self-Exempting Beliefs and Intention to Quit Smoking within a Socially Disadvantaged Australian Sample of Smokers. International Journal of Environmental Research and Public Health, 2016; 13(1).

30. Balmford J and Borland R. Smokers' perceptions of sources of advice about quitting: findings from the Australian arm of the ITC 4-country survey. Health Education Research, 2017; 32(2):124-33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28334770

31. Jones EF, Beniger JR, and Westoff CF. Pill and IUD discontinuation in the United States, 1970-1975: the influence of the media. Family planning perspectives, 1979; 12(6):293–300. Available from: http://europepmc.org/abstract/med/7202692

32. Chapman S, McLeod K, Wakefield M, and Holding S. Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis. Medical Journal of Australia, 2005; 183(5):247–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16138798

33. Dunlop SM, Cotter T, Perez D, and Chapman S. Tobacco in the news: associations between news coverage, news recall and smoking-related outcomes in a sample of Australian smokers and recent quitters. Health Education Research, 2011; 27(1):160–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22156232

34. Portnoy DB, Leach CR, Kaufman AR, Moser RP, and Alfano CM. Reduced fatalism and increased prevention behavior after two high-profile lung cancer events. Journal of Health Communication, 2014; 19(5):577-92.

35. Gravely S, Craig LV, Cummings KM, Ouimet J, Loewen R, et al. Smokers' cognitive and behavioural reactions during the early phase of the COVID-19 pandemic: Findings from the 2020 ITC Four Country Smoking and Vaping Survey. PLoS ONE, 2021; 16(6):e0252427. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34086706

36. Thrasher JF, Abad-Vivero EN, Huang L, O'Connor RJ, Hammond D, et al. Interpersonal communication about pictorial health warnings on cigarette packages: Policy-related influences and relationships with smoking cessation attempts. Social Science & Medicine, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26092600

37. Kasza KA, Hyland AJ, Borland R, McNeill A, Fong GT, et al. Cross-country comparison of smokers' reasons for thinking about quitting over time: findings from the International Tobacco Control Four Country Survey (ITC-4C), 2002–2015. Tobacco Control, 2017; 26(6):641-8. Available from: http://tobaccocontrol.bmj.com/content/tobaccocontrol/26/6/641.full.pdf

38. Hummel K, Nagelhout GE, Willemsen MC, Driezen P, Springvloet L, et al. Trends and socioeconomic differences in policy triggers for thinking about quitting smoking: Findings from the International Tobacco Control (ITC) Europe Surveys. Drug and Alcohol Dependence, 2015; 155:154-62. Available from: https://www.sciencedirect.com/science/article/pii/S0376871615010650

39. Durkin S, Brennan E, and Wakefield M. Mass media campaigns to promote smoking cessation among adults: An integrative review. Tobacco Control, 2012; 21:127–38. Available from: http://tobaccocontrol.bmj.com/content/21/2/127.short

40. Miller WR and Rollnick S, Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Publications; 2012. Available from: http://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274.

41. Panel TUaDG. Treating Tobacco Use and Dependence: 2008 Update. Rockville (MD): US Department of Health and Human Services, 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK63952/.

42. Borrelli B, McQuaid EL, Tooley EM, Busch AM, Hammond SK, et al. Motivating parents of kids with asthma to quit smoking: the effect of the teachable moment and increasing intervention intensity using a longitudinal randomized trial design. Addiction, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27184343

43. Steinberg ML, Ziedonis DM, Krejci JA, and Brandon TH. Motivational interviewing with personalized feedback: a brief intervention for motivating smokers with schizophrenia to seek treatment for tobacco dependence. Journal of Consulting and Clinical Psychology, 2004; 72(4):723-8.

44. Vinci C, Lam C, Schlechter CR, Shono Y, Vidrine JI, et al. Increasing treatment enrollment among smokers who are not motivated to quit: a randomized clinical trial. Transl Behav Med, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34424337

45. Catley D, Goggin K, Harris KJ, Richter KP, Williams K, et al. A Randomized Trial of Motivational Interviewing: Cessation Induction Among Smokers With Low Desire to Quit. American Journal of Preventive Medicine, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26711164

46. Rasu R, Thelen J, Agbor Bawa W, Goggin K, Bradley-Ewing A, et al. Motivational Interviewing to Encourage Quit Attempts among Smokers not ready to Quit: A Trial-Based Economic Analysis. Nicotine and Tobacco Research, 2019. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31820002

47. Klemperer EM, Streck JM, Lindson N, West JC, Su A, et al. A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit. Experimental and Clinical Psychopharmacology, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35771496