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

Last updated: March 2015

Suggested citation: Purcell, K, Greenhalgh, EM & Winstanley, MH. 3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2015. Available from http://www.tobaccoinaustralia.org.au/3-28-health-benefits-of-smoking-

 

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

Table 3.34.1
Drugs thought either to directly or indirectly cause the most deaths in Australia, population aged 14 and over, Australia 2010 and 2013

Drug

2010

2013

Tobacco

36

32

Alcohol

30

33.6

Heroin

16

14.1

Ecstasy/designer drugs

4

4.6

Cocaine

5

3.7

Meth/amphetamine

4.7

8.7

Other illicit drugs

9

0.5

Source: NDSHS 20131

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).

Table 3.34.2
Form of drug use thought to be of most serious concern for the general community, population aged 14 and over, Australia 2013

Drug

 

Tobacco

14.5

Alcohol

42.5

Heroin

10.7

Ecstasy

5.2

Meth/amphetamines

16.1

Cannabis

3.8

Cocaine

3.6

Other

 

Source: Derived from NDSHS 20131

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

Table 3.34.3
Drugs most likely to be associated with a 'drug problem', population aged 14 and over, Australia, 2013

Drug

% (rounded)

Males

Females

Tobacco

3

2

Alcohol

8

7

Heroin

25

26

Ecstasy

4

3

Methamphetamine

23

21

Cannabis

23

23

Cocaine

10

12

Source: Derived from NDSHS 20131

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%).

Table 3.34.4
Personal approval of the regular use by an adult of selected drugs, population aged 14 and over, Australia 2013

Drug

% (rounded)

Males

Females

Tobacco

17

12

Alcohol

52

39

Cannabis

13

7

Prescription pain killers

13

13

Over the counter pain killers

13

12

Ecstasy

3

2

Source: NDSHS 20131

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).

Table 3.34.5
Knowledge of health effects of smoking, Australia smokers aged 18+, by education and income, 2002

 

Percentage* agreeing that smoking is a cause of:

 

Lung cancer

Heart disease

Stroke

Impotence

Education level

Low

94

88

80

34

Medium

96

90

81

35

High

96

89

83

43

Income level

Low

92

86

78

36

Medium

94

89

81

35

High

97

91

84

37

TOTAL

94

89

81

36

*Percentages rounded

Source: Siahpush et al.2

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

Table 3.34.6
Unprompted awareness of illness and damage caused by smoking among smokers and people who have quit in the last year, aged 18–40, Australia 1997 to 2000

Smokers and recent quitters
(percentage)

Bench-mark
May 1997
(n=1192)

Follow-up 1
Nov 1997
(n=2981)

Follow-up 2
Nov 1998
(n=1647)

Follow-up 3
Nov 1999
(n=1612)

Follow-up 4
Nov 2000
(n=1675)

Believe there are illnesses or damage caused by smoking

95

93

95

95

94

Specific illness mentioned

Blocked blood arteries

9

13

12

12

9

Blocked blood vessels

3

6

6

6

6

Circulatory disease

4

7

5

8

5

Circulatory problems

8

11

10

12

10

Blood pressure

6

7

6

7

6

Any artery illness/damage

26

32

30

32

26

Emphysema

37

34

36

35

34

Lung damage

13

12

15

11

13

Lung cancer

64

62

61

62

66

Any lung illness/damage

80

79

79

80

80

Genetic/DNA damage

1

2

2

2

1

Heart disease

37

30

34

32

39

Cancer (unspecified)

34

34

32

37

32

Throat cancer

16

17

16

17

20

Clots in the brain

-

-

4

2

1

Brain damage

1

1

1

1

2

Stroke/vascular disease

3

2

8

6

5

Any brain disease

4

3

12

8

8

Eyesight damage

-

-

-

1

2

Source: Wakefield et al4

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

Table 3.34.7
Level of agreement with opinion statements about smoking and health (prompted awareness) among smokers and people who have quit in the last year, aged 18–40, Australia 1997 to 2000

Smokers and recent quitters

Bench-mark
May 1997
(n=1192)

Follow-up 1
Nov 1997
(n=2981)

Follow-up 2
Nov 1998
(n=1646)

Follow-up 3
Nov 1999
(n=1611)

Follow-up 4
Nov 2000
(n=1675)

Agree with opinion statements(%)

'Smoking causes lung cancer'

88

87

89

90

*na

'Smoking causes heart disease'

83

84

85

88

na

'Your smoking can harm others'

82

83

80

85

88

'Smoking causes emphysema'

86

86

86

88

na

'It would improve my health if I quit smoking'

93

93

94

95

na

Disagree with opinion statements (%)

'The dangers of smoking have been exaggerated'

59

64

61

64

68

'Smoking can't be all that bad because many people smoke all their lives and live to a ripe old age'

59

61

60

62

66

'Smoking the occasional cigarette doesn't cause any damage to your health'

50

57

55

57

60

* statements involving specific diseases that were almost universally agreed to be caused by smoking in earlier years were not repeated in the 2000 survey.

Source: Wakefield et al4

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

Table 3.34.8
Beliefs about personal risk of experiencing illness or harm from smoking among smokers and people who have quit in the last year, aged 18–40, 1997 to 2000

Smokers and recent quitters

Bench-mark
May 1997
(n=1192)

Follow-up 1
Nov 1997
(n=2981)

Follow-up 2
Nov 1998
(n=1646)

Follow-up 3
Nov 1999
(n=1611)

Follow-up 4
Nov 2000
(n=1675)

Likelihood of personally becoming ill from smoking: % of smokers agreeing that it is likely

45

52

50

50

53

Has smoking already done any harm to your body? % of smokers and recent quitters agreeing that it probably has

51

57

57

53

57

Source Wakefield et al4

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.

 

i As seen by the downward trend in smoking prevalence reported in older age groups between May 1997 and November 2000, the years during which the National Tobacco Campaign ran. (See Siahpush M, Borland R. Trends in socioeconomic variations in smoking prevalence, 1997-2000. In: Research and Evaluation Committee, editor. Australia's National Tobacco Campaign. Evaluation Report Volume 3. Every cigarette is doing you damage. Canberra: Commonwealth of Australia; 2004. p. 149-59)

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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

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