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

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3.0 Introduction

3.1 Smoking and heart disease

3.2 Respiratory diseases (excluding lung cancer)

3.3 Smoking and cancer

3.4 Lung cancer

3.5 Other cancers

3.6 Reproductive health

3.7 Pregnancy and smoking

3.8 Child health and maternal smoking before and after birth

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastro-intestinal diseases

3.13 Musculoskeletal diseases

3.14 Skin

3.15 The impact of smoking on treatment of disease

3.16 Smoking and diabetes

3.17 Inflammatory conditions and autoimmune disease

3.18 Other conditions with possible links to smoking

3.19 Smoking and accidents

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Poorer quality of life and loss of function

3.23 Smoking, dementia and cognitive decline

3.24 Genetic influences on tobacco-caused disease

3.25 Smoking compared with or in combination with other pollutants

3.26 Health effects of brands of tobacco products which claim or imply, delivery of 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 Smoking and body weight

3.30 Total burden of death and disease attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socio-economic 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 and other benefits of quitting

3.36 The global tobacco pandemic

3.34.1 Australian attitudes to tobacco as a drug

Findings from the National Drug Strategy Household Survey in 2013 show that as smoking rates continue to decline, fewer people think that tobacco is the drug that causes the most deaths (decreasing from 36% in 2010 to 32% in 2013). The drug perceived to be associated with the most deaths was alcohol (34.0%), followed by tobacco (32.0%) and heroin (14.1%)—see Table 3.34.1.¹

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 3.34.2). In 2013, among people aged 14 years or older, 42.5% thought that excessive alcohol drinking was the most concerning form of drug use for the general community. This was followed by meth/amphetamines, identified by 16.1% of people.¹ Tobacco smoking ranked third, at 14.5%. 

Males and females had similar perceptions about which drugs they thought were the most concerning for the community, but males were more concerned about smoking (16% compared with 13%), and females were more concerned about excessive alcohol use (44% compared with 41 %).

Different age groups were concerned about different drugs, with older people more concerned with excessive alcohol use (45% for those aged 50–59 years compared with 39% for those aged 20-29 years), and younger people more concerned with tobacco use (18% for those aged 14–19 compared with about 13% for those aged 50-59).

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 3.34.3).¹

Of all drugs used in Australia, alcohol has the greatest degree of personal approval, followed by pharmaceuticals (used for non-medical purposes) and tobacco (Table 3.34.4). 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 2013, people aged 14 years and over in the lowest socioeconomic group approved of regular tobacco use by adults more often than those in the highest socioeconomic group (19% compared with 11%, respectively), but were less likely to approve of regular adult alcohol use than those in the highest socioeconomic group (38% compared with 51 %). People in remote or very remote areas (16%), Indigenous Australians (24%), and those who identify as homosexual or bisexual (24%) approved of regular tobacco use more than people in major cities (14%), non-Indigenous Australians (15%), and people who identify as heterosexual (14%).

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 2002², a representative sample of Australian smokers was asked whether smoking causes lung cancer, heart disease, stroke and impotence. Awareness of the first three conditions was high across groups with vary levels of education and income (Table 3.34.5).

In 2004, 94% of Australian smokers surveyed as part of the same study agreed that smoking caused lung cancer, 89% agreed it caused heart disease, 81% agreed it caused stroke, 36% agreed it caused impotence and 69% agreed smoking caused lung cancer in non smokers.³

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 around 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.^2,3

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.⁴ 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 National Tobacco Campaign has had an impact on people aged under 18,⁵ and it is highly probable that population groups aged over 40 were also educated and influenced by the Campaign to some extent.ⁱ

Survey respondents in each year were asked whether, in their opinion, there were any illnesses caused by smoking (Table 3.34.6). 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.⁴

Respondents were also asked whether or not they agreed or disagreed with particular statements made about smoking (Table 3.34.7). 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.⁴ 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.'⁴

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 3.34.8).⁴

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.⁶ Attitudes to smoking are further explored in Chapter 6 and Chapter 7.

References

1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Cat. no. PHE 183 Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3 .

2. Siahpush M, McNeill A, Hammond D and Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tobacco Control 2006;15(suppl. 3):iii65-70. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/15/suppl_3/iii65

3. Hammond D, Fong GT, McNeill A, Borland R and Cummings KM. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control 2006;15(suppl. 3):iii19–25. Available from: http://tc.bmjjournals.com/cgi/content/abstract/15/suppl_3/iii19

4. Wakefield M, Freeman J and Inglis G. Changes associated with the national tobacco campaign: results of the third and fourth follow-up surveys, 1997-2000. In Hassard, K, ed. Australia's National Tobacco Campaign: evaluation report vol. 3. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Ageing, 2004;Available from:
http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/88ED1349FD03EB05CA257331000C3A17/$File/tobccamp3.pdf

5. White V, Tan N, Wakefield M and Hill D. Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign. Tobacco Control 2003;12(suppl. 2):ii23-9. Available from: http://tc.bmjjournals.com/cgi/content/abstract/12/suppl_2/ii23

6. 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;11:93-102. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16641076