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Smokers’ unrealistic optimism about their risk
  1. N D Weinstein1,
  2. S E Marcus2,
  3. R P Moser2
  1. 1Department of Human Ecology, Rutgers University, New Brunswick, New Jersey, USA
  2. 2Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
  1. Correspondence to:
 Neil D Weinstein PhD
 Department of Human Ecology, Rutgers University, Cook Office Building, 55 Dudley Road, New Brunswick, NJ 08901-8520, USA;


Objective: Past studies have produced ambiguous or inconsistent results when testing whether smokers actually underestimate their own risks of experiencing tobacco related illness. Whereas smokers claim that they are less at risk than the average smoker on self administered questionnaires, this unrealistic optimism has not been found in telephone or face-to-face interviews. We avoided the measurement problems of past studies and examined responses to a number of new questions to assess different aspects of smokers’ perceptions.

Methodology: A US national telephone survey (n  =  6369; 1245 current smokers) posed a variety of questions designed to examine beliefs about the risks of smoking. For key questions, separate samples of smokers were asked either about their own risk or about the risk of the average smoker.

Results: Smokers underestimated their relative risk compared to non-smokers and, contrary to previous interview surveys, believed they have a lower risk of developing lung cancer than the average smoker. Furthermore, their perceived risk of lung cancer and of cancer in general barely increases with the number of cigarettes smoked per day, and their estimates of their risk of cancer are actually slightly lower than their estimates of their risk of lung cancer. Substantial proportions of smokers and former smokers agree with several myths, more than half agreeing that exercise undoes most smoking effects.

Conclusion: Smokers underestimate their risk of lung cancer both relative to other smokers and to non-smokers and demonstrate other misunderstandings of smoking risks. Smoking cannot be interpreted as a choice made in the presence of full information about the potential harm.

  • risk accuracy
  • risk perception
  • smoking myths
  • unrealistic optimism

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  • * Sutton SR. Are smokers unrealistically optimistic about the health risks? Findings from two national surveys. Unpublished manuscript, Institute of Public Health, University of Cambridge.

  • Unpublished data from Sutton17 and Weinstein et al.18 In Sutton17 smokers were asked, “How do you think your own risk of dying from an illness caused by your smoking compares to the risk of the average smoker?”. The response scale ranged from “a lot less” coded as −2 to “a lot more” coded as +2. The mean response for smokers aged 15–19 (n  =  191) was −0.66, which was significantly less than zero, t  =  8.5, p < 0.0001 and for smokers over 19 (n  =  164), the mean was −0.01, NS. In Weinstein et al,18 smokers were asked, “Compared to the average smoker, do you think you are more likely to get sick from smoking [coded as +1], less likely to get sick from smoking [coded as −1], or that your chance of getting sick from smoking is about the same as the average smoker [coded as 0]?”. Mean responses were −0.05, NS, from smokers aged 14–22 (n  =  478) and 0.00, NS, from smokers over 22 (n  =  310).

  • Personal communication from Michael Thun and Jane Henley of the American Cancer Society concerning lung cancer risk data from Cancer Prevention Study II.

  • § Unpublished data from Sutton17 and Weinstein et al.18

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