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SRNT Conference, 2013
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 never-smokers 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.
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Smoking risk perceptions in Irish
adolescents with varied smoking experience
Louise Hopper & Dr Michael GormleyTrinity College, Dublin
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SRNT Conference, 2013
Presentation outline
Background• How risk impacts the smoking decision• Measuring risk
Research aims and design
Results
Conclusions
3
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SRNT Conference, 2013 44
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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SRNT Conference, 2013 55
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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SRNT Conference, 2013
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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SRNT Conference, 2013 77
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. Adolescent smokers, particularly daily smokers, would show
an optimistic risk bias for perceived relative risk of smoking
2. An optimistic bias would also be seen when immediate and
general harm of smoking were compared.
3. Cognitive avoidance of health-related risks was expected in
smokers but not in non-smokers
4. General attitudes to risk were expected to vary by smoking
status
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SRNT Conference, 2013
Research Design
Participants
N = 602
Daily
Smoker
N = 145
Weekly
Smoker
N = 35
Ex-Smoker
N = 35
Experimental
Smoker
N = 130
Never
Smoker
N = 257
Between Group
Dependent Variables
•Relative to General Risk•Relative to Smoker Risk•General Harm from Smoking•Immediate Harm from Smoking•Avoid Thoughts of Health Risks•Domain Specific Risk (DOSPERT)
Optimistic Bias?
Optimistic Bias?
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SRNT Conference, 2013
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 ….’
10
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 cigarette11
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SRNT Conference, 2013
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
12
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SRNT Conference, 2013
Participant CharacteristicsDaily
(n = 145)Weekly(n = 35)
Ex-S(n = 35)
Experimental(n 130)
Never(n = 257)
Mean Age 16.86(0.99)
16.77(1.00)
16.89(1.02)
16.58(1.01)
16.41(0.92)
Age Started Smoking 13.17(2.27)
14.80(1.58)
Age Daily Smoker 14.37(2.14)
Cig per Day 10.89(6.24)
Cig per Week 66.07(43.48)
9.27(6.95)
Dependence (FTND) 3.03(2.39)
0.26(0.56)
13
On average:
Weekly smokers have made 1.8 quit attempts (SD = 1.23) Daily smokers have made 5.0 quit attempts (SD = 10.57)
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SRNT Conference, 2013
Results : Relative Risk
Daily Weekly Ex- Exper Never-4
5
6
7
8
9
10
11
to General to Smoker
Smoking Status
Mean
Harm
Rati
ng
Daily smokers rate relative risk significantly higher than all other smoking groups (p < .001)
No impact of measure => no optimistic bias
14
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
Significant main effect of smoking status, F(4,597) = 57.53, p<.001, ŋp2 = .28
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Results : Relative Health Risk
Daily Weekly Exper. Ex- Never-2
3
4
5
6
7
8
to General to Smoker
Smoking Status
Mean
Harm
Rati
ng
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
15
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
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SRNT Conference, 2013
Results : Relative Addiction Risk
Daily Weekly Ex- Exper Never-1
1.5
2
2.5
3
3.5
4
to General to Smoker
Smoking Status
Mean
Harm
Rati
ng
Main effect of measure (p < .05)• For non-smokers only
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
16
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
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SRNT Conference, 2013
Results : Avoid Health Risk Thoughts
Daily Weekly Ex- Exper Never-0
0.5
1
1.5
2
2.5
3
3.5
4
Smoking Status
Mea
n A
void
ance
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)
17
5 (smoking status) Factorial ANOVA
Significant main effect of smoking status, F(4,579) = 28.03, p<.001, ŋp2 = .16
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SRNT Conference, 2013
Results : Perceived Harm
Daily Weekly Exper. Ex- Never-2
2.5
3
3.5
4
General Immediate
Smoking Status
Mean
Harm
Rati
ng
Significant main effect of measure (p<.001)
Lower estimates were given for immediate harm regardless of smoking status
Significant main effect of smoking status (p<.001)
Daily and weekly smokers differ significantly from never (p<.001) and experimental (p<.01) smokers.
18
5 (smoking status) x 2 (measure) Multi-Factorial ANOVA
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SRNT Conference, 2013
Results : DOSPERT Scales
Daily Weekly Exper. Ex- Never-0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Social Recreational Health & Safety
Smoking Status
Mea
n D
OS
PE
RT
Sco
re
19
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SRNT Conference, 2013
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 harm-related
bias which illustrates the importance of understanding
the context of the risk assessment (i.e. long-term vs.
short-term risk)20
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SRNT Conference, 2013
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
21
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SRNT Conference, 2013
ReferencesBlais, 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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Thank you for your attention
QuestionsLouise Hopper
School of Psychology, TCD
Acknowledgement:This research was funded by a post graduate scholarship from Trinity College Dublin.