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

Purpose: To evaluate whether adolescents understand the risks of smoking wh en they decide to start. Estimates of objective risks that can be compared with epidemiologic evidence suggest that adolescents overstate the risks. R atings 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. Responden ts estimated both objective and personal risks of smoking, and smokers repo rted their plans to quit. Objective estimates were compared with both epide miologic evidence and personal ratings of risk. Regression procedures were used to assess relationships between different estimates of risk and betwee n risk estimates and plans to quit. Results: Two of the three objective estimates of risk revealed high proport ions of misunderstanding. Over 40% of smokers and 25% of nonsmokers underes timated, 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 owin g 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 r isks of smoking regardless of their perceptions of objective risk. Both obj ective and personal measures of risk predicted plans to quit. Conclusions: Because perceptions of both personal and objective risks are r elated to plans to quit, antismoking messages should include evidence about risk, particularly to the individual smoker. (C) Society for Adolescent Me dicine, 2001.