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Reassessing the importance of ‘lost pleasure’ associated with smoking cessation: implications for social welfare and policy
  1. Terry Frank Pechacek1,2,
  2. Pratibha Nayak3,
  3. Paul Slovic4,
  4. Scott R Weaver1,5,
  5. Jidong Huang1,2,
  6. Michael P Eriksen1,2
  1. 1 Georgia State University’s Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
  2. 2 Division of Health Management & Policy, Georgia State University, Atlanta, Georgia, USA
  3. 3 Public Health Research & Translational Science, Battelle Memorial Institute, Atlanta, Georgia, USA
  4. 4 Decision Research, Eugene, Oregon, USA
  5. 5 Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, Georgia, USA
  1. Correspondence to Dr Terry Frank Pechacek, School of Public Health, Tobacco Center of Regulatory Science, Georgia State University, Urban Life Building, Atlanta, Georgia 30303, USA; tpechacek{at}


Introduction Benefit–cost analyses of tobacco regulations include estimates of the informed choice of smokers to continue smoking. Few studies have focused on subjective feelings associated with continued smoking. This study estimates how smoker discontent and regret relate to risk perceptions and health concerns.

Methods We analysed data from a 2015 nationally representative, online survey of 1284 US adult current smokers. Information was collected on regret, intention to quit, perceived addiction, risk perceptions and health concerns. Multivariate logistic regression adjusting for sociodemographics and health status was used to examine factors associated with smoker discontent.

Results More than 80% of current smokers report high (22.5%) or very high (59.8%) discontent due to inability to quit, perceived addiction and regret about having started to smoke. Higher levels of discontent did not vary significantly by sex, age, race/ethnicity, education or income (adjusted odds ratios (AORs) 0.5–1.2). Compared with the smokers expressing low (5.9%) or very low (3.6%) discontent, those expressing higher levels of discontent perceived their health status as fair/poor (AOR=2.3), worried most of the time about lung cancer (AOR=4.6) and felt they were more likely to develop lung cancer in the future (AOR=5.1).

Conclusion The proportion of smokers who might be characterised as having a preference to continue smoking are greatly outnumbered by addicted, discontent and concerned smokers who want to quit and regret ever having started to smoke. These discontent smokers could have a substantial net welfare gain if new regulations helped them escape their concerns about the health effects from continuing smoking.

  • economics
  • addiction
  • public policy
  • packaging and labelling
  • public opinion

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors TFP and PN designed the study and conceptualised the data analysis. PN analysed the data. All authors contributed to interpretation. TFP, PN, SRW, PS and JH contributed to writing and reviewing drafts of manuscript. MPE assisted with the design of the parent study, reviewed drafts of the manuscript and providing critically input on design of the figures.

  • Funding This study was supported by grant number P50DA036128 from the National Institutes of Health, National Institute on Drug Abuse and Food and Drug Administration, Center for Tobacco Products. The author MPE receives funding from Pfizer, and all other authors of this paper report no other financial disclosures.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Georgia State University’s Institutional Review Boards (GSU IRB# H14028) and Federal Wide Assurance Number 00000129.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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