The Smoking Puzzle: Information, Risk Perception, and Choice - Hardcover

Sloan, Frank A.; Smith, V. Kerry; Taylor Jr., Donald H.

Hardcover

ISBN 10: 0674010396 ISBN 13: 9780674010390

Publisher: Harvard University Press, 2003

Synopsis

How do smokers evaluate evidence that smoking harms health? Some evidence suggests that smokers overestimate health risks from smoking. This book challenges this conclusion. The authors find that smokers tend to be overly optimistic about their longevity and future health if they quit later in life.

Older adults' decisions to quit smoking require personal experience with the serious health impacts associated with smoking. Smokers over fifty revise their risk perceptions only after experiencing a major health shock--such as a heart attack. But less serious symptoms, such as shortness of breath, do not cause changes in perceptions. Waiting for such a jolt to occur is imprudent.

The authors show that well-crafted messages about how smoking affects quality of life can greatly affect current perceptions of smoking risks. If smokers are informed of long-term consequences of a disease, and if they are told that quitting can indeed come too late, they are able to evaluate the risks of smoking more accurately, and act accordingly.

About this title

About the Authors

Frank A. Sloan is J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics, Duke University.

V. Kerry Smith is University Distinguished Professor in the Department of Agricultural and Resource Economics, North Carolina State University.

Donald H. Taylor Jr. is Assistant Research Professor, Sanford Institute of Public Policy, Duke University.

Reviews

Warning: the surgeon general has determined that smoking cigarettes increases the chance that you will need to ask your closest friends and relatives to assist you in bathing, using the bathroom, preparing meals, shopping, and taking care of your most basic necessities during the last months or years of your life. This warning label does not appear in the scholarly book by Sloan and his coauthors, but if the avenue of research they propose is carried out, something like it may be used in the not-too-distant future. In this book, the authors have taken on the tasks of developing and (much more difficult) quantifying effective strategies to persuade late-middle-aged smokers to quit smoking. Many information campaigns about the dangers of smoking are directed specifically at younger people (for excellent reasons), and one might think that older smokers are hopelessly entrenched and simply immune to basic health messages. The writers have obvious sympathy for the millions of smokers who became addicted before the advent of warning labels on cigarettes -- a product that can be excruciatingly difficult to give up. The authors' stated goal in this book is to "break down the smoking puzzle into its constituent elements -- information, risk perception, and smoking behavior." And they achieve this with a modest but authoritative presentation of their own work, combined with examinations of other research on the subject. The discussions and conclusions presented are readily accessible to the lay professional, but the detailed analysis of methods and results might best be appreciated by epidemiologists, economists, and others familiar with statistical analysis. The results of focus-group studies carried out by the authors, like many great discoveries, are almost obvious. The most effective deterrents to smoking for people who have been addicted for decades are highly personalized: for instance, the advent of a major smoking-related illness to the smoker or a close family member. Since many smokers may reason (not illogically) "We all have to go some-time . . .," health messages that stress the possible loss of a few years of life are simply not as effective as bringing home the realization that the end of life may not come quickly and painlessly but might well entail considerable helplessness and disability, a dread to which we can all relate. I was delighted with the authors' suggestions for further research, which included the idea that information campaigns that emphasize quitting might also give advice on how to avoid gaining weight in the process. That message is scholarly common sense at its best. The authors suggest, and I agree, that with so many lives at stake, much more must be done to translate disease risks to personal action and tailor messages to fit the needs of any given population subgroup. Luis G. Escobedo, M.D., M.P.H.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Edition details

• Publisher: Harvard University Press
• Publication date: 2003
• Language: English
• ISBN 10: 0674010396
• ISBN 13: 9780674010390
• Binding: Hardcover
• Edition number: 1
• Number of pages: 288