In some years, smokers have been asked the open-ended question "What do you think would be the main advantages to you, if you gave up smoking?". The main advantages smokers anticipated if they gave up are presented in Table 5. As the data indicates, the most important factors for smokers over the ten years were general health issues and improving fitness. "Feeling healthier" increased significantly between 1983 and 1991 (43% to 57%, 95%CI of diff= 6.5 to 21.5). Saving money was also an issue, but its importance did not increase. Avoidance of cancer in the long term did not seem to be an issue for many smokers in any year. There was a significant decrease in the proportion who could see no advantages to quitting between 1983 and 1991 (16% to 10%, 95%CI of diff= 0.7 to 11.3).
| 1983 | 1985 | 1986 | 1988 | 1991 | |
|---|---|---|---|---|---|
n= |
224 | 792 | 767 | 675 | 633 |
| Improve fitness | 25% | 23% | 26% | 29% | 29% |
| Feel healthier | 43% | 57% | 59% | 59% | 57% |
| Avoid cancer | 6% | 4% | 3% | 4% | 3% |
| Save money | 49% | 46% | 45% | 44% | 45% |
| Total advantages | 84% | 88% | 90% | 92% | 91% |
| Total no advantages | 16% | 12% | 10% | 8% | 10% |
Between 1983 and 1991, smokers were also asked what they expected would be the main disadvantages of quitting smoking. Table 6 presents the most frequently expected disadvantages.
| 1983 | 1985 | 1986 | 1988 | 1991 | |
|---|---|---|---|---|---|
n= |
224 | 792 | 767 | 675 | 633 |
| Put on weight | 23% | 28% | 24% | 21% | 19% |
| Make irritable | 25% | 28% | 24% | 20% | 19% |
| Cause craving | 3% | 8% | 7% | 5% | 3% |
| Hard to cope with stress | 9% | 9% | 7% | 8% | 7% |
| Social situations difficult | 4% | 3% | 3% | 3% | 2% |
| Difficult to concentrate | 1% | 3% | 1% | 1% | 1% |
| Other disadvantages | 5% | 7% | 7% | 7% | 6% |
| Total disadvantages | 60% | 65% | 58% | 50% | 48% |
| Total no disadvantages | 40% | 35% | 42% | 50% | 52% |
As Table 6 indicates, between 1983 and 1991 the total number of respondents who said that quitting had some disadvantages decreased from 60% to 48% (95%CI of diff= 4.5 to 19.5). The number who mentioned no disadvantages to quitting smoking rose from 40% to 52% (95%CI of diff= 4.5 to 19.5). The more commonly perceived disadvantages to quitting smoking were "put on weight" and "make irritable", and these also showed the most decline between 1983 and 1991, though the changes were quite small.
The proportion of ex-smokers perceiving advantages to having quit smoking changed between 1983 and 1985, but then remained relatively constant between 1985 and 1991 (see Table 7). The advantages they experienced were very similar to those expected by smokers. "Feeling healthier", "improve fitness", and "save money" were the most commonly mentioned advantages to quitting smoking for the former smokers. There was a significant increase in the proportion of people who mentioned "save money" as an advantage to quitting smoking between 1983 and 1991 (95%CI of diff= 5.5 to 22.5), but this change had occurred very early.
| 1983 | 1985 | 1986 | 1991 | |
|---|---|---|---|---|
n= |
131 | 544 | 580 | 661 |
| Feel healthier | 42% | 53% | 52% | 51% |
| Improve fitness | 37% | 24% | 33% | 35% |
| Avoid cancer | 2% | 2% | 2% | 1% |
| Save money | 27% | 41% | 39% | 41% |
| Total advantages | 89% | 88% | 90% | 90% |
| Total no advantages | 11% | 12% | 10% | 10% |
Former smokers were also asked about the main disadvantages of quitting, and it was found that current smokers expected more disadvantages than the ex-smokers reported having experienced. The main perceived disadvantages to quitting smoking for former smokers were also relatively constant between 1983 and 1991 (see Table 8). "Weight gain", "irritability", and "cravings" were the problems most frequently mentioned as being experienced when quitting smoking, though very few people mentioned even them.
| 1983 | 1985 | 1986 | 1991 | |
|---|---|---|---|---|
n= |
131 | 544 | 580 | 661 |
| Put on weight | 11% | 15% | 16% | 14% |
| Make irritable | 5% | 7% | 6% | 5% |
| Cause craving | 5% | 56% | 5% | 7% |
| Hard to cope with stress | 3% | 2% | 2% | 2% |
| Social situations difficult | 2% | 4% | 4% | 3% |
| Difficult to concentrate | * | 1% | 1% | * |
| Other disadvantages | 5% | 7% | 5% | 4% |
| Total disadvantages | 27% | 33% | 32% | 31% |
| Total no disadvantages | 73% | 67% | 68% | 69% |
In each year, the former smokers were asked, "About how long ago did you finally give up smoking cigarettes?". They were shown a card which gave twelve different time periods, ranging from "one to seven days" to "ten years or more" to select from. As Table 9 shows, in each year the overwhelming majority had quit more than a year ago and the rest were spread out over the preceding year.
| '83 | '84 | '85 | '86 | '87 | '89 | '90 | '91 | '92 | '93 | |
|---|---|---|---|---|---|---|---|---|---|---|
n= |
305 | 250 | 544 | 564 | 527 | 526 | 623 | 661 | 649 | 668 |
| <3 months | 5% | 7% | 6% | 9% | 6% | 6% | 6% | 6% | 5% | 7% |
| >3 < 6 months | 4% | 4% | 4% | 3% | 4% | 5% | 5% | 3% | 4% | 3% |
| >6 < 12 months | 8% | 6% | 5% | 5% | 5% | 5% | 4% | 3% | 5% | 4% |
| >1 < 2 years ago | 6% | 10% | 7% | 9% | 7% | 7% | 9% | 6% | 7% | 7% |
| >2 < 5 years ago | 19% | 16% | 20% | 20% | 15% | 18% | 18% | 20% | 15% | 15% |
| >5 years ago | 54% | 52% | 56% | 53% | 53% | 56% | 58% | 61% | 60% | 62% |
| Can't say | 4% | 6% | 2% | 3% | 10% | 3% | 1% | 1% | 4% | 2% |
All respondents - smokers, ex-smokers and never smokers - were asked "In your opinion, are there any illnesses caused by smoking?". Those who said "yes" were then asked to name the illnesses. As there was a wide range of illnesses mentioned, Table 10 only gives the percentage of respondents spontaneously mentioning some of the main ones.
Between 1983 and 1993 there was an increase of 9% in the proportion of respondents who said smoking caused health problems and could name at least one (95%CI of diff= 6.0 to 12.0). The most dramatic increase was for emphysema (22% to 46%) which was specifically targeted in the advertisement Stairs. There was also an increase in awareness of asthma, from the very low awareness of 2% in 1983 to 20% in 1993. Asthma has not been specifically mentioned in any advertisements about active smoking, but its link with passive smoking and children was mentioned in the Whose Habit advertisement. It is interesting to note that people are far more likely to mention asthma when asked about passive smoking than just "smoking" (see chapter 3).
| '83 | '84 | '85 | '86 | '87 | '88 | '89 | '90 | '91 | '92 | '93 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
n= |
648 | - | 2613 | 2499 | 2331 | 2251 | 2334 | - | 2440 | 2355 | 2387 |
| Lung cancer | 68% | - | 59% | 57% | 54% | 62% | 58% | - | 62% | 62% | 58% |
| Other cancer* | 18% | - | 33% | 32% | 30% | 31% | 37% | - | 33% | 34% | 36% |
| Emphysema | 22% | - | 24% | 33% | 38% | 41% | 45% | - | 51% | 48% | 46% |
| Heart disease | 22% | - | 34% | 31% | 34% | 34% | 37% | - | 33% | 35% | 36% |
| Asthma | 2% | - | 7% | 8% | 5% | 9% | 12% | - | 13% | 17% | 20% |
| At least one illness named | 84% | - | 89% | 90% | 90% | 92% | 92% | - | 94% | 92% | 93% |
| No illness caused | 14% | - | 11% | 10% | 10% | 8% | 8% | - | 6% | 8% | 8% |
There has been a decline in the proportion naming 'lung cancer'. It is implausible that people have genuinely become less aware of lung cancer's association with smoking. It is more likely that, when asked a free recall question about illnesses, people will only name a limited number. Therefore mentions of lung cancer may have declined because of the increased salience of other illnesses.
Respondents were also asked about any health problems which might be helped by smoking. In 1983, nearly one-quarter of the respondents (24%) said they believed at least one problem could be helped by smoking, and 18% still maintained this belief in 1993. In each year, the health problems most commonly thought to be eased by smoking were "stress" and "nerves". Strangely, 3% of people in 1983 and 1% in 1993 actually believed asthma could be helped by smoking.
| 1983 | 1985 | 1986 | 1988 | 1991 | 1992 | 1993 | |
|---|---|---|---|---|---|---|---|
n= |
648 | 2613 | 2499 | 2251 | 2440 | 2355 | 2387 |
| Nerves | 16% | 17% | 12% | 10% | 9% | 7% | 6% |
| Stress | - | 2% | 6% | 6% | 7% | 7% | 8% |
| Asthma | 3% | 1% | 1% | 1% | 1% | 1% | 1% |
| Mental illness | 1% | 1% | 1% | 1% | 1% | 1% | 1% |
| Overweight | 3% | 2% | 2% | 1% | 1% | 1% | 1% |
| High blood pressure | - | - | * | * | 1% | * | * |
| Other problems | 3% | 2% | 2% | 2% | 1% | 2% | 3% |
| Total problems helped | 24% | 25$ | 21% | 18% | 18% | 17% | 18% |
| No problems helped | 74% | 75% | 79% | 80% | 82% | 82% | 82% |
| Can't say | 2% | 2% | 1% | 1% | 1% | 1% | * |
Data on smoking-related knowledge, attitudes and behaviour has been monitored in Victoria since 1983. Since that time there has been a significant decrease in the proportion of Victorians over the age of 16 who smoke. Increase in the intention to quit in the next 3 months has also increased - by 1993, 51% said it was likely they would try. There had also been an increase in the proportion who thought the chance of getting a fatal illness was greater than 50% if they continued to smoke.
Looking at some of the barriers and benefits of quitting, it was apparent that in the nineties, most smokers believed at least one person would be in favour of their quitting. The profile of people considered most in favour had not changed, but there had been increases since 1985 in the proportion of young respondents (16 to 19 years old) who thought that their mother would like them to quit, and more parents with children under 16 thought their sons and daughters would like them to stop.
Smokers in 1991 were more likely to perceive advantages to quitting, and less likely to perceive disadvantages. "Feel healthier" was the main factor seen as more important in the nineties.
Among those who had quit smoking, there had been no change in the proportion perceiving advantages or disadvantages. This is not surprising given that response to this question is based on experience, and there is no reason to expect the experience would have changed.
Smokers, past smokers and never smokers were all asked about the illnesses smoking could cause. The proportion of people who could name at least one illness had increased significantly between 1983 and 1993. Emphysema, asthma, and cancers other than lung cancer showed the greatest increases.
This data indicates that, by 1993, smokers were more likely to intend to quit, and perceived a greater risk from their smoking than smokers had in 1983. They also perceived there would be advantages to quitting, and most expected strong social support if they quit. The population as a whole was more aware of illnesses caused by smoking. It is encouraging that smokers have improved on all of these measures. It is disturbing however, that despite this improved knowledge and more positive attitudes to quitting, smokers are not quitting at greater rates.
Health Department Victoria. Ministerial Review into Health Promotion. Melbourne: Victorian Government Printing Service, 1985.
Hill D, Gray N. Australian patterns of tobacco smoking and health-related beliefs in 1983. Community Health Studies 1984; 8: 307 - 316.