Copy of abstract submitted

Background: Health behaviour models suggest that perceived vulnerability to harm and the balance of
perceived risks and benefits guide smoking decisions. Although there is substantial support for this
model among adults, results in terms of how adolescents understand smoking risk are inconsistent. This
study aimed to develop an understanding of how adolescent daily, weekly, experimental, ex-, and neversmokers perceive smoking risk.

Method: 602 adolescents (145 daily, 35 weekly, 35 ex, 130 experimental, 257 never smokers) completed
a smoking perceptions survey which included questions related to the perception of health and addiction
risk, and the perceived general and immediate harm from smoking, avoidance of health-related thoughts,
and 3 subscales from a domain specific measure of risk (DOSPERT) relating to social, recreational, and
health and safety risk.

Results: Daily smokers differed significantly to all other groups on general risk measures (p<.001 for
each). They perceived higher levels of relative risk and were less optimistic about the risks, but they were
significantly less likely to perceive general or immediate harm from smoking. They were less likely to
avoid health risks than never (p<.001), experimental (p<.001), and ex-smokers (p<.05), whereas weekly
smokers only differed significantly from never-smokers (p<.05). Weekly smokers also perceived less
general harm from smoking than never (p<.001) and experimental (p<.01) smokers. No smoking status
differences were seen in overall levels of domain specific risk-taking (DOSPERT) but significant
differences are found for social risk between never and daily smokers (p<.05) and for health and safety
risks between never- and ex- (p<.05), weekly (p<.05), and daily (p<.001) smokers.

Discussion: These findings suggest that risk is an important factor in adolescent smoking decisions.
They challenge the contention that adolescent smokers are not aware of the risks involved with smoking
but despite this awareness, regular smokers seem more inclined to take health-related risks and are less
concerned about immediate harm from smoking. Further examination of DOSPERT risk assessment in
adolescents is recommended.
SRNT Conference, 2013
Smoking risk
perceptions in Irish
adolescents with varied
smoking experience
Louise Hopper & Dr Michael Gormley
Trinity College, Dublin
Presentation outline

Background
• How risk impacts the smoking decision
• Measuring risk

Research aims and design

Results

Conclusions
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Making the smoking decision

Rather than disregarding the relationship
between smoking and its associated risks, it has
been suggested that:
•
•
Smokers rationally weigh-up the risks against the
benefits of smoking (Viscusi, 1992)
Smokers engage in cognitive strategies, such as
cognitive avoidance, that help maintain their current
behaviour (Gerrard, et al., 1996)

Cognitive avoidance of behavioural risk can move from
motivated to unmotivated and habitual with increased
exposure and experience
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Adolescents and Smoking Risk

Smokers, especially young smokers, seem to be
driven by the affective context of smoking decisions
(Slovic, 2001), giving little or no conscious thought to
the risks involved
•

Evidence that adolescents display greater risk-taking for affective
decisions in comparison to more deliberate ones (Figner, et al.,
2009)
But, there is also evidence that adolescent smokers
are aware of, and freely endorse, the long-term risk
consequences of smoking (Brady, et al., 2008;
Lewis-Esquerre, et al., 2005)
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Optimistic Risk Bias

Despite this endorsement of long-term smoking
risk, adolescents tend to
•
•

Underestimate short-term smoking risk (Slovic, 1998)
In particular addiction risk (Weinstein, 2001)
AND
•
perceptions of short-term immediate harm from
smoking influences adolescent smoking behaviour to
a greater extent than longer-term smoking risk (Romer
& Jamieson, 2001)
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Measuring Risk

Numerical risk estimates
•
•
•
•

Participant estimates risk and this is compared to actuarial or
epidemiological risk tables (Schoenbaum, 1997)
Often used in adult research
But it assumes that people have the ability to be able to assign a
numerical value to the risk (Borland, 1997)
Inappropriate for adolescent risk studies
Comparative risk estimates (Relative Risk)
•
•
•
Participants to compare their own risk with that of an average
person (Sutton & Bolling, 2003)
Avoids issues with numerical risk estimates
Allows measurement of bias in the personal risk assessment
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Research Aims

Determine how adolescents of varied smoking status
perceive smoking-related risk

Based on previous research, it was expected that:
1.
2.
3.
4.
Adolescent smokers, particularly daily smokers, would show an
optimistic risk bias for perceived relative risk of smoking
An optimistic bias would also be seen when immediate and
general harm of smoking were compared.
Cognitive avoidance of health-related risks was expected in
smokers but not in non-smokers
General attitudes to risk were expected to vary by smoking
status
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Research Design
Between
Group
Participants
N = 602
Daily
Smoker
N = 145
Dependent
Variables
Weekly
Smoker
N = 35
•
•
•
•
•
•
Ex-Smoker
N = 35
Experimental
Smoker
N = 130
Never
Smoker
N = 257
Relative to General Risk
Optimistic Bias?
Relative to Smoker Risk
General Harm from Smoking
Optimistic Bias?
Immediate Harm from Smoking
Avoid Thoughts of Health Risks
Domain Specific Risk (DOSPERT)
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Relative Smoking Risk

Relative to general (RG)
•

‘Compared to other people your age how likely do you
think you are to …..’
Relative to smoker (RS)
•
‘Compared with a typical smoker your age how likely
do you think you are to ….’
Much less
likely
A bit less
likely
About the
same
A bit more
likely
Much more
likely
Get lung cancer in the future
(
)
(
)
(
)
(
)
(
)
Have a heart attack in the future
(
)
(
)
(
)
(
)
(
)
Be hooked on cigarettes in 5 years
(
)
(
)
(
)
(
)
(
)
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Perceived Harm from Smoking

General Harm : responses 1 to 4 (risky)
•
•
•

How risky do you think smoking is for your health?
How risky do you think smoking every day would be for your
health?’
The harmful effects of cigarettes have been exaggerated. Do you
___?’
Immediate Harm: responses 1 to 4 (risky)
Imagine someone who starts to smoke a packet of cigarettes a day
at age 16. How much do you agree with the following statements
about this person?


There is usually no risk at all to the person for the first few years
Although smoking may eventually harm this person’s health, there is
really no harm to him or her from smoking the very next cigarette
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General risk-related items

Avoiding health-related thoughts
• ‘How likely is concern for your health to
influence your decision to smoke or not to
smoke?’ 1 (very likely) to 7 (very unlikely)

General attitudes to risk taking
• DOSPERT scale (Blais & Weber, 2006)
• Social, Recreational, and Health & Safety
subscales only
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Participant Characteristics
Mean Age
Age Started Smoking
Age Daily Smoker
Cig per Day
Daily
(n = 145)
Weekly
(n = 35)
16.86
16.77
16.89
16.58
16.41
(0.99)
(1.00)
(1.02)
(1.01)
(0.92)
13.17
14.80
(2.27)
(1.58)
14.37
On average:
(2.14)
Weekly smokers have
made 1.8 quit attempts
(SD = 1.23)
10.89
(6.24)
Cig per Week
Ex-S Experimental Never
(n = 35)
(n 130)
(n = 257)
66.07
9.27
(43.48)
(6.95)
3.03
0.26
(2.39)
(0.56)
Dependence (FTND)
SRNT Conference, 2013
Daily smokers have made
5.0 quit attempts
(SD = 10.57)
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Results : Relative Risk
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
Significant main effect of smoking status, F(4,597) = 57.53, p<.001, ŋp2 = .28
to General
to Smoker
Mean Harm Rating
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
Daily smokers rate
relative risk
significantly higher
than all other
smoking groups
(p < .001)

No impact of
measure => no
optimistic bias
10
9
8
7
6
5
4
Daily
Weekly
Ex-
Exper
Never-
Smoking Status
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Results : Relative Health Risk
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
to General
to Smoker
Mean Harm Rating
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
Main effect of
smoking status only
(p < .001)

Daily smokers rate
relative risk
significantly higher
than all other
smoking groups (p <
.001)

No impact of
measure => no
optimistic bias
7
6
5
4
3
2
Daily
Weekly Exper.
ExSmoking Status
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Never-
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Results : Relative Addiction Risk
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
to General
to Smoker

Mean Harm Rating
4
Main effect of
measure (p < .05)
•
3.5

Main effect of smoking
status (p < .001)

Daily smokers rate
relative addiction risk
significantly higher
than all other smoking
groups (p < .001)

No impact of measure
within the smoking
groups => no
optimistic bias
3
2.5
2
1.5
1
Daily
Weekly
ExExper
Smoking Status
SRNT Conference, 2013
Never-
For non-smokers only
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Results : Avoid Health Risk Thoughts
5 (smoking status) Factorial ANOVA
Mean Avoidance
Significant main effect of smoking status, F(4,579) = 28.03, p<.001, ŋp2 = .16
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Daily Weekly ExExper NeverSmoking Status
SRNT Conference, 2013

Clear distinction between
smokers and non-smokers

Daily smokers avoid
thinking about health-risks
to a greater extent than
ex-smokers (p < .05),
experimental (p < .001)
and never smokers
(p < .001)

Weekly smokers also
score higher than
experimental and never
(p < .05)
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Results : Perceived Harm
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
General
Immediate

Significant main effect
of measure (p<.001)

Lower estimates were
given for immediate
harm regardless of
smoking status
3

Significant main effect
of smoking status
(p<.001)
2.5

Daily and weekly
smokers differ
significantly from
never (p<.001) and
experimental (p<.01)
smokers.
Mean Harm Rating
4
3.5
2
Daily
Weekly Exper.
ExSmoking Status
SRNT Conference, 2013
Never-
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Results : DOSPERT Scales
Mean DOSPERT Score
Social
Recreational
Health & Safety
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Daily
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Weekly
Exper.
Smoking Status
Ex-
Never19
Summary

Results support the idea that risk is an important
factor in adolescent smoking, but ...

Challenge the contention that adolescent smokers
are not generally aware of the risks associated
with smoking, yet ....

Smokers do appear to exhibit an optimistic harmrelated bias which illustrates the importance of
understanding the context of the risk assessment
(i.e. long-term vs. short-term risk)
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Conclusion

Adolescent smokers generally avoid health-related
thoughts to a greater extent than non-smokers, which
suggests that some implicit or habitual cognitive
avoidance process is triggered when making a
smoking-related decision

Future Research
•
•
Comparison of risk profiles across different age groups in
order to determine the developmental nature of the
understanding of perceived risk
Further examination of the DOSPERT risk assessment
measure in adolescents
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References
Blais, A.-R., & Weber, E. U. (2006). A Domain-Specific Risk-Taking (DOSPERT) scale for adult populations. Judgment
and Decision Making, 1(1), 33-47.
Borland, R. (1997). What do people's estimates of smoking related risk mean? Psychology & Health, 12(4), 513-521.
Brady, S. S., Song, A. V., & Halpern-Felsher, B. L. (2008). Adolescents report both positive and negative
consequences of experimentation with cigarette use. Preventive Medicine: An International Journal Devoted to
Practice and Theory, 46(6), 585-590.
Figner, B., Mackinlay, R. J., Wilkening, F., & Weber, E. U. (2009). Affective and deliberative processes in risky choice:
Age differences in risk taking in the Columbia Card Task. Journal of Experimental Psychology: Learning, Memory,
and Cognition, 35(3), 709-730.
Gerrard, M., Gibbons, F. X., Benthin, A. C., & Hessling, R. M. (1996). A longitudinal study of the reciprocal nature of
risk behaviors and cognitions in adolescents: What you do shapes what you think, and vice versa. Health
Psychology, 15(5), 344-354.
Lewis-Esquerre, J., Rodrigue, J. R., & Kahler, C. W. (2005). Development and validation of an adolescent smoking
consequences questionnaire. Nicotine & Tobacco Research, 7(1), 81-90.
Romer, D., & Hennessy, M. (2007). A biosocial-affect model of adolescent sensation seeking: The role of affect
evaluation and peer-group influence in adolescent drug use. Prevention Science, 8(2), 89-101.
Schoenbaum, M. (1997). Do smokers understand the mortality effects of smoking? Evidence from the health and
retirement survey. American Journal of Public Health, 87(5), 755-759.
Slovic, P. (1998). Do Adolescent Smokers Know the Risks? Duke Law Journal, 47(6), 1133-1141.
Slovic, P. (2001). Cigarette smokers: Rational actors or rational fools? In P. Slovic (Ed.), Smoking: Risk, perception, &
policy. (pp. 97-124). Thousand Oaks, CA US: Sage Publications, Inc.
Sutton, S., & Bolling, K. D. (2003). Adolescents' perceptions of the risks and prevalence of smoking. Zeitschrift für
Gesundheitspsychologie, 11(3), 107-111.
Viscusi, W. K. (1992). Smoking: Making the risky decision. New York, NY US: Oxford University Press.
Weinstein, N. D. (2001). Smokers' recognition of their vulnerability to harm. In P. Slovic (Ed.), Smoking: Risk,
perception, & policy. (pp. 81-96). Thousand Oaks, CA US: Sage Publications, Inc.
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Acknowledgement:
This research was funded by a post graduate
scholarship from Trinity College Dublin.
Thank you for your
attention
Louise Hopper
School of Psychology, TCD
hopperl@tcd.ie
Questions
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