Quit Evaluation Studies: Volume
Smoking knowledge, attitudes and behaviour: Results of the 1992 Household
This paper reports on a household survey conducted in 1992 to collect detailed
information about smokers' and non-smokers' knowledge, beliefs, attitudes
and behaviour about smoking. Household surveys have been carried out annually
in Victoria since 1983, and results published in the Quit Evaluation series
since the first volume in 1985. In the early surveys, assessments of the
activities in Quit's campaign period were included, but since the introduction
of annual post-campaign telephone surveys in 1989, the household survey
has focused on smoking behaviour and health-related beliefs. Some of the
questions in the household survey are included to assess changes over time,
and others are of specific research in a particular year. As 1992 was the
tenth annual survey, and there is a chapter on trends across surveys in
this volume (see Chapter 5), the main focus here
is on the situation in 1992, rather than on changes over time.
The household surveys are commissioned from Roy Morgan Research Centre,
a large market research company which regularly interviews a representative
sample of Victorians in their own homes. The questions designed by the Centre
for Behavioural Research in Cancer form part of an omnibus survey, and are
included in a survey commencing early in October and running over eight
weekends. The method used to collect the information in 1992 was the same
as that used in previous years, and a full description of this method can
be found in Hill and Gray (1984).
The sample comprised 2355 Victorians aged 16 years and over who were interviewed
between 10 October and 14 November 1992. Half the sample were men and half
women. Twenty-five per cent of the sample were aged between 16 and 29, 41%
between 30 and 49 and the remainder were 50 or over.
To test for the significance of relationships between variables, various
statistics have been used, mainly chi-square tests, t-tests, and analyses
of variance. Details of statistical tests are not given in the text. Where
relationships between variables are reported, the probability level of significance
was less than 0.05, indicating a less than 1 in 20 chance that the finding
is due solely to chance.
In order to look at demographic differences in the data, age has been divided
into three categories: 16 to 29 years old; 30 to 49 years old; and 50 years
and over. Educational attainment was divided into four categories: Year
9 or less; Year 10 or 11; completed Year 12 but not university; and completed
tertiary education. Unless otherwise stated, occupational status is based
on that of the main income earner in the household, classified as upper
or lower white collar or upper or lower blue collar. Only 41% of the sample
worked full time, making classification by the respondent's own occupational
This report does not present the data in the same order as the questions
were asked in the survey.
Tobacco use in Victoria
Respondents to the survey were categorised as current smokers, past smokers
and never smokers according to their self-report. The current smokers were
those who smoked cigarettes and/or cigars and/or pipes at present; the past
smokers were those who had smoked cigarettes and/or cigars and/or pipes
in the past; and the never smokers had not ever smoked regularly.
In 1992, 25.7% of the sample were current smokers, 27.6% were past smokers
and 46.5% had never smoked at all. The proportion of men (27.5%) and women
(24.0%) who smoked was not significantly different (95%CI of diff= -0.2
to 7.3; ns). However, as in previous years the sex composition of the non-smoking
groups did differ. Far more women (53.9%) than men (40.2%) reported never
having smoked at all, and more men (33.6%) than women (21.5%) had given
The average number of cigarettes smoked each day was calculated for those
who said they smoked every day from information provided on number of packs
smoked a week and usual pack smoked. Overall, they smoked an average of
19.7 cigarettes per day. Men smoked more (20.8 per day) than women (18.4).
The 16- to 29-year-old smokers smoked less (15.9) than either the 30- to
49-year-olds (21.7), or those over 50 (20.1). There was also an effect for
education, with those who had completed Year 9 or less smoking more on average
(22.3) than those who had completed Year 12 (18.5) or those who had tertiary
education (14.3). There was an overall effect for occupation, but no two
occupational groups were significantly different at the 0.05 level.
Smoking in Melbourne and other parts of Victoria
Many people believe that smoking prevalence is higher in country areas than
in the city. To assess this, smoking prevalence and cigarette consumption
in Melbourne and the rest of Victoria was compared for men and women in
the age groups 16 to 29 years old, 30 to 49 years old and 50 years or older.
Table 1 shows the proportion of people in each group who describe themselves
Table 1 Proportion of smokers in Melbourne and rural areas by age
||Melb ||Not Melb ||Melb
The 95% confidence intervals indicate there is no real difference between
smoking prevalence in Melbourne and elsewhere either for men overall, or
for any of the specific age groups. However, all trends were for higher
prevalence of smoking in those not from Melbourne. For women, there was
a difference in the prevalence of smoking among those from Melbourne and
elsewhere (95%CI of diff= 1.4% to 12.2%). The biggest difference was among
the 16- to 29-year-olds, with 10.8% higher smoking prevalence among the
Figure 1 presents the average amount smoked each day by men and women, for
the daily smokers only. A 3-way anova was conducted to test for effects.
There was a main effect for region, indicating that people in regional areas
smoke more heavily than those in Melbourne. There were no interactions for
age or sex.
Figure 1 Smoking in Melbourne and other parts of Victoria by sex
Overall, it seems that women in other parts of Victoria smoke more than
women in Melbourne, and this is particularly true of the younger age groups.
Country men may also smoke more. Smoking consumption is also higher in country
areas than in Melbourne.
History of giving up smoking
In this survey, 27.6% of respondents (649 people) classified themselves
as having stopped smoking. More than half the ex-smokers had not been smoking
for quite some time - 39% had quit 10 years ago or more, and another 21%
had done so at least five years ago giving 60% as relatively long-term quitters.
At the other extreme, 3% had stopped smoking only within the last four weeks,
3% for more than four weeks but less than three months, and 9% for three
months to 12 months. The rest had quit for between one and two years (7%),
or two to five years (15%). Four per cent said they had no idea how long
it was since they had given up.
The current smokers (n=606) were asked about their previous attempts to
quit - both the number of attempts they had made, and the length of time
since their last attempts. The vast majority of the sample, 82%, had tried
to quit at least once. Most respondents had made multiple attempts, with
only 15% saying they had tried just once. Twenty-two per cent had made five
or more attempts. There was no difference in the number of attempts to quit
by sex, age, educational level or occupation.
Nearly half of those who had tried to quit (46%) had done so within the
last twelve months, and another quarter (23%) between one and two years
ago. Fourteen per cent had tried between two and five years ago, and only
15% had not tried to quit for more than five years.
Figure 2 shows quitting activity over the past 12 months, by combining the
data on the current smokers' attempts to quit during that time, and the
percentage of former smokers who have quit within the last 12 months. It
is assumed that the smokers and those who quit in the past 12 months were
smoking a year ago, which will not be so in a small percentage of cases.
Figure 2 Quitting activity over the past 12 months
As Figure 2 shows, there has been a high level of quitting activity in the
past 12 months, but also a high level of relapse. A proportion of those
currently stopped are also likely to relapse. If a greater percentage of
attempts to quit could be converted into successful attempts, the impact
on smoking prevalence would be dramatic.
Smokers' intentions of giving up
As well as asking smokers about their previous attempts to quit, two questions
were used to assess their intentions of quitting. The first asked each smoker
to say how likely he or she was to give up smoking in the next three months.
The respondent was handed a card listing seven response options, ranging
from "extremely unlikely" to "extremely likely". This
gave a measure of their intention of quitting in the immediate future. In
addition, respondents were asked a question based on
Prochaska and Di Clemente's (1983) stages-of-change model, which will
be discussed later.
Smokers were evenly divided in their intention of quitting or not, with
exactly the same proportion (45%) rating themselves as "slightly",
"quite" or "extremely likely" to give up smoking in
the next three months, as saying they were "slightly", "quite"
or "extremely unlikely" to give up. The others either said they
were "neither likely or unlikely" (9%) or could not say (1%).
Respondents were categorised as either "likely", "not likely"
or "neither likely or unlikely" to quit, and chi-square tests
were conducted to test for any relationship between intention to quit and
sex, age, educational level or occupation. There was no relationship between
intention to quit and any demographic variable.
In addition to this measure of immediate intention to quit, respondents
were also presented with a ladder developed by Biener
and Abrams (1991) based on Prochaska
and Di Clemente's stages-of-change model of quitting. This model suggests
that smokers pass through a number of stages on their way to quitting, from
a stage of precontemplation, when they are not even thinking of quitting,
through to an action stage where they actually do something about giving
up. They may cycle through the various stages several times before quitting.
The ladder has rungs numbered from zero to ten, five of them with descriptive
labels attached. The bottom rung, '0', is labelled "I have no thought
of quitting", '2' is labelled "I need to consider quitting some
day"; rung '5' is labelled "I think I should quit, but I am not
quite ready"; '8' says "I am starting to think about how to change
my smoking patterns; and '10' is "I am taking action to quit".
Smokers were asked to pick where they were on the ladder in relation to
quitting, and could pick either a labelled rung or an unlabelled one.
Twelve per cent of respondents placed themselves on the top rung of the
ladder, indicating that they were currently doing something about quitting,
and 9% rated themselves as zero - no thought of quitting.
Analysis-of-variance and post-hoc comparisons indicated that the oldest
age group, those aged 50 or over, were less advanced on the ladder (mean
= 4.3) than either of the two younger age groups (5.7 and 5.5 respectively).
Those who had Year 9 education or less were less advanced on the ladder
(4.8) than those who had completed Year 12 (5.9) or who had a tertiary education
(6.2). There were no other demographic differences.
Social support for quitting
The expectation that people around them would approve of the smoker quitting
may be an important factor in encouraging smokers to try to stop. To assess
the sort of response smokers expected to get if they quit, they were asked
who would be in favour of, and who would be against, them giving up smoking.
They first identified the person who would be most in favour, then every
other person who would be in favour of it, followed by the person most against,
and all others aganst it.
Table 2 People in favour of the respondent giving up smoking (n=606)
in favour of giving up ||Total in
favour of giving up|
relative ||2% ||9%|
|Own doctor ||2%
|Can't say ||1%
As in previous years, the smoker's spouse or partner was most commonly perceived
as being in favour of him or her quitting. It is notable that if the respondent
mentioned his or her spouse, they were usually mentioned first. This was
particularly true for men (45%) and for those aged between 30 and 49 years
of age (50%). In the youngest age group, 16 to 29, mothers (63%) and fathers
(45%) were commonly seen to be in favour of the respondent quitting. Of
those respondents with children under the age of 16, 51% said their sons
would like them to quit, and 53% said their daughters would.
Eighty-nine per cent of respondents could not name anyone who would be against
them giving up smoking. There were a few people (4%) who had friends they
thought would not approve of them quitting, and two per cent had a spouse
or partner who would not.
Knowledge of sources of information about quitting
To assess people's knowledge of the places smokers could get help and information
about giving up smoking, they were asked to name all the places such help
and information was available. This question was not restricted to smokers,
but was asked of all respondents, and all but about 10% of respondents could
name at least one source. Doctors (26%) and the Quit Line (23%) were most
commonly mentioned first.
Table 3 gives the total proportion of respondents mentioning each source,
either a first or subsequent mention, and only for those sources named by
at least 5% of respondents.
Table 3 Sources of help and information about giving up smoking (total
||Current smoker ||Past
smoker ||Never smoked|
||606 ||649 ||1247|
Line ||34% ||39%
|Quit Campaign ||28%
|Anti-Cancer Council ||16%
|Health centre ||8%
Department ||7% ||4%
|Heart Foundation ||5%
at least one ||91% ||94%
Clearly, doctors are perceived by many people, particularly those who smoke,
as the main source of help and information about smoking, with nearly two-thirds
of respondents naming them. Many people also mentioned Quit, either specifying
the Quit Line (34%) or the Quit Campaign (28%). Ten per cent more smokers
(70%) than never smokers (60%) mentioned doctors, but on the whole there
was little difference in the reported sources, by the different smoking
Doctor's advice about quitting
Doctors and other health professionals could play a major part in encouraging
their patients to stop smoking, if they were prepared to take on that role.
The extent to which smokers remember doctors talking to them about smoking
was assessed in the household survey in 1990 (Mullins
& Borland, 1993). The key findings were that 55% of smokers reported
their doctor had not advised them to quit smoking, and for 22% this was
despite saying the doctor had asked if they smoked. Patients who had been
advised to quit smoking were more likely to have attempted to quit (81%)
than those to whom the doctor had said nothing (61%). Patients who had been
advised to cut down on their smoking, rather than to quit, were less likely
to be planning a quit attempt (27%) than any others.
Since that data was collected, Quit has introduced a program to encourage
general practitioners to advise their patients to quit smoking. The intervention
is a simple one involving the regular mailing of copies of The Can Quit
Book to all GPs, with a letter encouraging them to give the booklet to their
patients who smoke. A full evaluation of the program will be included in
the next Quit Evaluation Studies volume; this paper looks only at the data
generated by the household survey question.
The method used in 1992 was identical to that in 1990, when smokers were
shown a card, and asked, "Which if any of those things has your doctor
ever said to you?". The options presented were the same as the ones
in 1990; however, there were some slight changes in the wording to make
them easier to understand. The 1992 options are shown below, with the 1990
options in brackets if they were changed.
The question allowed for multiple responses. To analyse the responses, mutually
exclusive categories were created by developing a hierarchy of response,
and each respondent was coded according to the most appropriate advice he
or she had been given. This hierarchy was: given information or help to
stop smoking; advised to stop smoking; advised to cut down; asked if smoked
but given no advice or help to stop; not asked if smoked; advised to keep
smoking. Thus, if a respondent had been advised to stop smoking as well
as being given help to achieve this, they were classified as having been
given information or help. The ten respondents who claimed they had been
advised to keep smoking were excluded from the analysis to eliminate the
problem of small cell sizes.
- Asked if you smoked (Asked you whether you smoked or not)
- Advised you to stop smoking
- Advised you to cut down on your smoking (Advised you to cut down your
- Given you information or help to stop smoking (Given you information
and assistance to stop smoking)
- Advised you to contact the Quit Campaign for help
- Advised you to go to a stop-smoking course (Recommended you attend
a quit-smoking course)
- Advised you to get help from a therapist (Recommended you get help
from an individual therapist )
- Advised you to keep smoking
Table 4 Doctor's advice to smokers about smoking by sex and age
| || || ||Sex
||1990 || ||Male
||Female ||16-29 ||30-49
||320 ||276 ||173
|Info or help to stop ||11%
|Advised to stop smoking ||35%
|Advised to cut down ||11%
|Asked if smoked ||22%
Overall, the pattern of response had not changed significantly since 1990..
The small changes were all in the right direction; small increases in the
proportion advised to stop or given information or help to stop, and small
decreases in the numbers who said smoking was not discussed, told only that
they should cut down or asked if they smoked but given no advice about it.
In 1992, there was no significant effect for sex, but there was for age.
People who were 50 or over were far more likely to say their doctor had
never mentioned smoking than people under 50.
Thirty-six per cent of smokers in the 1992 survey reported that they had
a copy of The Can Quit Book, and nearly one-third of these (31%) said they
had got it from their doctor. Doctors were by far the most common single
source of the book, even compared with the next most reported source, which
was hospitals (13%). Only 10% of smokers with the book had got it by contacting
the Quit Campaign office.
There were 64 respondents who said they had got The Can Quit Book from their
doctor, but of these only 19 said their doctor had given them information
or help to stop smoking. Twenty-two of them said they had been advised to
stop, but not given any help or advice, 10 claimed they had been asked if
they smoked but not advised to quit, six said they were told to cut down,
and seven that smoking was not mentioned at all. Some of these people may
have simply picked up a booklet at their doctors, but the data also suggests
that some people do not classify being given a booklet as "information
or help", or even as advice.
For the first time, in 1992, non-smoking respondents were asked whether
their doctor had ever asked if they smoked. The former smokers were asked
a very similar question to the one the current smokers were asked, except
it was phrased in the past tense. Two additional options were also included:
'Asked if you smoked after you stopped smoking', and 'given you encouragement
after you stopped'. Respondents who had never smoked were simply asked "Has
your doctor ever asked if you smoke or not?".
Nearly one-quarter of the former smokers (23%) reported that since they
had stopped smoking they had been asked whether they smoked, but only 6%
said they had received any encouragement from their doctor after they stopped
smoking. Only one ex-smoker reported being advised to continue to smoke.
To look at reported advice before quitting, in Table 5, the two options
appropriate for after quitting have been excluded, and a hierarchy the same
as that presented for smokers is presented.
Table 5 Doctor's advice to ex-smokers about smoking by sex and age
| || ||Sex
||Total ||Male ||Female
||16-29 ||30-49 ||50+|
|551 ||331 ||218
||86 ||200 ||265|
| || || || || |
|Info or help to stop ||7%
to stop smoking ||27% ||31%
|Advised to cut down ||2%
if smoked ||16% ||15%
As the data in Table 5 indicates, nearly half the former smokers reported
that the issue of smoking had not been raised with them while they smoked.
Again, there was no difference in the advice given to men and women, but
there was for age. Older smokers were most likely to say their doctor had
not mentioned smoking (but also most likely to say they had been advised
Some of the former smokers had given up a considerable time ago, and may
not actually recall any advice they were given, so a breakdown was done
looking only at those who had quit in the last two years (n=125). Eleven
per cent of those who had quit in that time said they had been given information
or help to stop, and 43% had been advised to do so. This represents an increased
percentage recalling advice compared with ex-smokers overall, and also means
54% of recent quitters were in the desirable categories, compared with 50%
of those still smoking. This difference is not significant.
Among those who had never smoked, 60% reported having been asked if they
smoked. Those aged 30 to 49 years were most likely to have been asked (70%).
Awareness of The Can Quit Book
The Quit Campaign's main print resource for those trying to stop smoking
is the booklet The Can Quit Book, produced in 1989, which has been shown
to be of use in prompting smokers to take action to try to quit (Borland,
Lee & Scollo, 1991). A huge number of these books have been distributed,
but previously there has not been an attempt to determine awareness of it
across the population. The booklets are distributed from a wide range of
sources, and are also sent to many of the people who ring Quit seeking help.
In this survey we showed respondents a copy of the cover of the booklet
and asked "Have you got, or ever read, a copy of this booklet?".
The question was phrased in a way which allowed those respondents who may
once have had a copy, or who had read someone else's to respond positively.
Those who had were then asked "Where did you get, or read, this booklet?".
Table 6 presents data on the awareness of the books, and then on the places
people got them from.
Table 6 Sources of The Can Quit Book by smoking status
||Current smoker ||Past
smoker ||Never smoked|
|2355 ||606 ||649
read booklet ||22% ||36%
|Not got or read ||77%
sure if got or read ||2% ||1%
Main sources of booklet for those who've got or ever read it
|508 ||217 ||120
|Contacted Quit ||8%
|In mail ||5%
say ||9% ||8%
As would be expected, more of the current smokers (36%) had copies or had
read copies of The Can Quit Book than any other group, although a surprisingly
high percentage of past smokers (19%) and never smokers (16%) also owned
or had read copies.
Health professionals or health services were the main sources of The Can
Quit Book. Most people had accessed their copies through a doctor, including
those who had never smoked. Non-smokers may have requested the booklet for
someone else or may have just picked it up if it was available in the waiting
Of those who had never smoked, 10% said they received The Can Quit Book
in the mail, which should only happen if they, or someone else, requested
it be sent to them. Another 6% said they had got it by contacting Quit.
Quit do receive a fair number of calls from people requesting literature
to help others to quit, but these figures are still implausibly high.