In addition to its cardiovascular dangers, smoking presents significant risks to oral health, ranging from bad breath to periodontitis to oral cancer. But while three out of four Americans agree that cigarettes cause health problems, public perceptions of the risks posed by smoking may be declining, according to Duke Health. Plus, the change in risk perception also changed more significantly in women than in men.
From 2006 to 2015, the number of Americans who said smoking a pack or more per day posed a great health risk dropped by 1%, representing more than 3 million people. So far, the change has not appeared to have resulted in more smokers, as the number of smokers in the United States dropped from 20.8% to 15.1% during the same period, the Centers for Disease Control and Prevention reports. Yet the Duke researchers think it could signal slower progress.
“That’s 3 million people who might be more likely to start smoking, go back to smoking, or who are less likely to quit if they already smoke,” said Lauren Pacek, PhD, lead author and an assistant professor in psychiatry and behavioral sciences at Duke.
“We were surprised by the findings,” said coauthor Joe McClernon, PhD, professor of psychiatry and behavioral sciences. “Cigarettes haven’t fundamentally changed over the last 15 years. They’re no safer. And we continue to see that large numbers of Americans are dying from tobacco-related disease—as many as 400,000 a year. So, it’s curious that the facts haven’t change, but the risk perceptions have gone down.”
The findings are based on responses from more than 559,000 people over the age of 12 years who took the National Survey on Drug Use and Health, an in-home survey administered by the Substance Abuse and Mental Health Services Administration since the 1970s. The survey asks: “How much do people risk harming themselves physically and in other ways when they smoke one or more packs of cigarettes per day?”
Respondents selected no, slight, moderate, or great risk. As the number of respondents who saw smoking as a great risk declined, the number who said it posed no risk increased, jumping from 1.45% to 2.63% over the 10-year span. Older teens and adults were more likely than teens age 12 to 17 to see smoking as a great health risk. Daily smokers were less likely than former smokers and non-smokers to see cigarette use as dangerous to their health.
A number of factors could be driving the change, McClernon said, including message fatigue.
“The idea here is that Americans have heard so often, and for so long, about how harmful cigarettes are that the message is less impactful,” said McClernon said, adding that it may also be possible that fewer Americans know smokers or people with tobacco-related disease, which could further decrease perceived harm.
“We’d like to see public policy experts and population health advocates look at these findings, step back, and work on ways to increase public perception of the cigarette smoking risks,” McClernon said. “Maybe that’s through public education campaigns or changes in tobacco product labelling. We think our data suggest that there are some segments of the population—women and young teens, for instance—who might benefit more from these efforts.”
The researchers are conducting several ongoing projects to examine how different tobacco products, such as electronic cigarettes, influence people’s perception of smoking risks or the decision to quit. The study, “Decline in the perceived risk of cigarette smoking between 2006 and 2015: Findings from a U.S. nationally representative sample,” was published by Drug and Alcohol Dependence.
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