One-third of smokers who develop cancer quit smoking after their diagnosis.1 Why does it take a crisis of this magnitude to make them stop? This article throws light on why a simple awareness of risk may not be enough to make a smoker quit.
Giving up smoking is not easy – how to quit will probably be the subject of a future post. But quitting requires intent, intent requires motive, and motivation begins with knowledge.
But isn’t everybody aware of the health risks of tobacco use? Of course, they are. I have not met a single smoker who doesn’t know that smoking is dangerous or that it causes cancer. In fact, research shows that 90% of smokers regret that they ever started smoking.2 Then why do they continue to smoke?
An interesting paper by Chapman and Liberman3 describes the “four levels of being informed” about the risk of smoking.
Level 1: Having heard that smoking increases health risks. This is simply a vague awareness, and although this kind of awareness is widespread, it is unlikely to motivate anybody to quit smoking.
Level 2: Being aware that specific diseases are caused by smoking. This is less common than level 1 awareness – an Australian study showed that only about half of smokers mentioned lung cancer as a smoking-related illness!4 More importantly, most people are not aware of the full range of diseases caused by smoking – which includes at least 18 different types of cancers and 32 non-cancerous diseases like cardiovascular illness, stroke, lung failure, limb gangrene, impotence, infertility, blindness, deafness, and arthritis.5
Level 3: Accurately appreciating the meaning, severity, and probabilities of developing tobacco-related diseases. What is the life of a patient with throat cancer like? How does someone with bladder cancer suffer? How long after diagnosis does the average lung cancer patient live? How much higher is the chance for a smoker to get colon cancer compared to a non-smoker? Most smokers do not completely understand exactly what smoking can do to their health.
Level 4: Personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases. Smokers tend to feel that the risks are not relevant to them personally. They rationalize – “Statistics are just statistics. It won’t happen to me.” “My father smoked for 30 years – nothing happened to him.” “My neighbor never smoked a single day in his life – he still got cancer.” Most do not comprehend the fact that two out of three long-term smokers die because of a smoking-related illness.6
To summarize, the right level of knowledge is a prerequisite to motivate someone to give up smoking. This knowledge will inspire a smoker to seek out ways and means to address his addiction. It should not require a life-changing diagnosis of cancer to make a smoker quit.
- Tseng, T. S., Lin, H. Y., Moody-Thomas, S., Martin, M., & Chen, T. (2012). Who tended to continue smoking after cancer diagnosis: the national health and nutrition examination survey 1999-2008. BMC public health, 12, 784. https://doi.org/10.1186/1471-2458-12-784
- Fong, G. T., Hammond, D., Laux, F. L., Zanna, M. P., Cummings, K. M., Borland, R., & Ross, H. (2004). The near-universal experience of regret among smokers in four countries: findings from the International Tobacco Control Policy Evaluation Survey. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 6 Suppl 3, S341–S351. https://doi.org/10.1080/14622200412331320743
- Chapman S, Liberman J. Ensuring smokers are adequately informed: reflections on consumer rights, manufacturer responsibilities, and policy implications. https://tobaccocontrol.bmj.com/content/14/suppl_2/ii8
- Mullins R, Borland R, Hill D. Smoking knowledge, attitudes and behaviour in Victoria: Results from the 1990 and 1991 Household Surveys. In: Victorian Smoking and Health Program. Quit Evaluation Studies No 6. Melbourne: Victorian Smoking and Health Program, 1995, http://www.quit.org.au/quit/QE6/QE6Ch1.html.
- Committee on the Public Health Implications of Raising the Minimum Age for Purchasing Tobacco Products; Board on Population Health and Public Health Practice; Institute of Medicine; Bonnie RJ, Stratton K, Kwan LY, editors. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Washington (DC): National Academies Press (US); 2015 Jul 23. 4, The Effects of Tobacco Use on Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310413/
- 45 and Up Study Collaborators, Cohort Profile: The 45 and Up Study, International Journal of Epidemiology, Volume 37, Issue 5, October 2008, Pages 941–947, https://doi.org/10.1093/ije/dym184