Do adolescents appreciate the risks of smoking? Evidence from a national survey

Purpose: To evaluate whether adolescents understand the risks of smoking when they decide to start. Estimates of objective risks that can be compared with epidemiologic evidence suggest that adolescents overstate the risks. Ratings of personal risk suggest the opposite. Methods: A nationally representative telephone survey of 300 14- to 22-year-old nonsmokers and 300 14- to 22-year-old smokers was conducted. Respondents estimated both objective and personal risks of smoking, and smokers reported their plans to quit. Objective estimates were compared with both epidemiologic evidence and personal ratings of risk. Regression procedures were used to assess relationships between different estimates of risk and between risk estimates and plans to quit. Results: Two of the three objective estimates of risk revealed high proportions of misunderstanding. Over 40% of smokers and 25% of nonsmokers underestimated, or did not know, the likelihood of smoking-related death, and over 40% did not know, or underestimated, the number of years of life lost owing to smoking. Although young people overestimated lung cancer risk relative to objective data, these estimates are inflated by underestimation of the fatality of lung cancer and by overlap with other illnesses not included in objective risk measures. Young smokers exhibited optimism about personal risks of smoking regardless of their perceptions of objective risk. Both objective and personal measures of risk predicted plans to quit. Conclusions: Because perceptions of both personal and objective risks are related to plans to quit, antismoking messages should include evidence about risk, particularly to the individual smoker. (C) Society for Adolescent Medicine, 2001.