Optimistic bias and perceived control among cigarette smokers.

Abstract

Studies have shown that cigarette smokers are generally aware of increased health risks associated with smoking, but that smokers tend to underestimate their own susceptibility to disease. In general, optimistic bias has been shown to increase with greater perceived control over an event or behavior; however, this phenomenon has not been examined with regard to cigarette smoking in particular. In this study, 95 cigarette smokers answered a questionnaire that examined optimistic bias, perceived control over smoking, and :factors that influenced smoking behavior. It was hypothesized that greater perceived control would correspond with greater optimistic bias. It was also hypothesized that factors influencing smoking would explain more variance in optimistic bias than perceived control alone. Results indicated optimistic bias for this sample of smokers, which is consistent with previous studies, however, perceived control did not explain a significant proportion of variance in optimistic bias. Implications are discussed in relation to developing effective smoking cessation programs.

Introduction

Since the early 20th century, cigarette smoking has become the preferred method of tobacco use in the United States, with approximately 53 million cigarette smokers (Lichtenstein & Glasgow, 1992). Even considering the addictive properties of nicotine, the number of people who continue to risk their lives by smoking is staggering. Why? While it is possible that many smokers are unaware of the risks of their behavior, educational efforts over past 30 years make it unlikely that smokers would not have at least some knowledge of health problems associated with smoking. In fact, research shows that smokers are generally aware of increased health risks (McCoy, et al., 1992; Strecher, Kreuter, & Kobrin, 1995).

One possible explanation for continued widespread smoking lies in smokers' perceived likelihood of contracting a smoking related illness. One of the principal variables in many current models of individual preventive behavior is the perceived susceptibility to a given threat (Weinstein, 1988). The Health Belief Model (Becker, 1974) and Transtheoretical Model (McKenzie & Smeltzer, 1997) predict that smokers who perceive less threat to their health from smoking will be less likely to take precautions to reduce that threat. Despite the fact that most smokers are generally aware of health risks, this knowledge does not necessarily result in perception of increased individual susceptibility to a disease. It follows from both the Transtheoretical and Health Belief Models that this limited perceived susceptibility would result in greater optimistic bias among smokers.

Possible discrepancies between awareness of the health risks of smoking and perceived susceptibility by individual smokers can be explained by unrealistic optimism, or optimistic bias. Unrealistic optimism refers to either an individual's overestimation of the likelihood of experiencing a positive event, or an individual's underestimation of the likelihood of experiencing a negative event (Weinstein, 1980). Specifically, people tend to be optimistically biased about susceptibility to health problems (Weinstein, 1984, 1987).

While smokers tend to acknowledge greater susceptibility to smoking related illnesses than nonsmokers, research has shown that individual smokers do tend to exhibit optimistic bias when comparing themselves to other smokers (McCoy, et al., 1992; Strecher, Kreuter, & Kobrin, 1995). Specifically, McCoy and colleagues asked current smokers, former smokers, and nonsmokers to rate the risks of developing certain smoking related illnesses (i.e. coronary heart disease, lung cancer, and emphysema). Participants were asked to assess their likelihood of contracting one of these diseases across three conditions: themselves as smokers, themselves as nonsmokers, and a typical smoker. The authors found that smokers tended to predict lower likelihood of illness for themselves as smokers than for a typical smoker, exhibiting an optimistic bias. Additionally, when comparing ratings of self-as-smoker to self-as-nonsmoker, current smokers tended to perceive the least benefit not smoking compared to former smokers and nonsmokers. Thus, current smokers tend to believe that they personally are at less risk than smokers in general and tend to underestimate the benefits of quitting smoking compared with former smokers and nonsmokers.

Arnett (2000) examined optimistic bias among adolescents and adults smokers and nonsmokers. Arnett confirmed earlier findings of significant differences in general health optimistic bias between nonsmokers and smokers among samples of both adolescents and adults. Smokers were twice as likely as nonsmokers to believe they would not die from smoking related causes if they smoked 30 or 40 years. Interestingly, 60% of the 48 adolescents who reported they had smoked a cigarette in the past 30 days, believed they could quit smoking in a few years. A total of 48% of the 47 adult smokers reported their same belief that they could quit smoking. These findings, while limited by small sample sizes, may point to multiple levels of optimistic bias among smokers. Not only do smokers exhibit greater optimistic bias concerning their chances of contract a smoking-related disease than nonsmokers, they also exhibit greater optimistic bias concerning their ability to quit smoking.

Knowing that smokers tend to be optimistically biased, it becomes important that we find out how optimistic bias varies among different groups of smokers. Determining which smokers are more likely to be optimistically biased would be useful for designing intervention strategies more effectively for different types of smokers. Perceived control over smoking behavior is one factor that may determine level of optimistic bias. In fact, Jenks (1992) found that smokers who perceived themselves as addicted to smoking (i.e., having less control) tended to be less satisfied with their health and feel they had less control over their lives than nonsmokers and former smokers.

The National Institutes of Health (NIH) posts six different factors that influence smoking behavior (NIH, 1984). The types of smokers theorized by the NIH report include smoking for stimulation, handling cigarettes, accentuation of pleasure or pleasurable relaxation, reduction of negative feelings or "crutch", craving or strong addiction, and habit. It is possible that the factors which lead to smoking behavior may have a stronger predictive value for optimistic bias than a simple perception of control or addiction. It is anticipated that certain factors would be associated with greater control over the behavior (e.g., stimulation, handling, and pleasurable relaxation) and that smokers who attribute their behavior to these factors would be predicted to be more optimistically biased than smokers who attribute their behavior to less controllable factors (e.g., habit). The current study is the first empirical examination of the usefulness of this NIH smoking assessment instrument as it relates to optimistic bias and perceived control. The smoker-types identified by the NIH factors may be important to understanding causes of optimistic bias among smokers.

This study examines optimistic bias regarding coronary heart disease, lung cancer, and emphysema among cigarette smokers and explores the effects of perceived control over smoking and the NIH smoking factors on optimistic bias. We hypothesized that smokers will display an overall optimistic bias regarding smoking related illnesses. We also hypothesized that those who perceive greater control over their smoking will exhibit greater optimistic bias than those who believe themselves more addicted. Since there is no previously published research on the utility of the NIH smoker-types, we tentatively hypothesized that the NIH factors influencing smoking behavior will explain more variance than perceived control alone, with the smoker categories of stimulation, handling, and pleasurable relaxation being most closely associated with optimistic bias.

Method

Participants

Ninety-five current cigarette smokers (34 males, 61 females) with an average age of 40.0 years (SD=13.6) were asked to participate as part of a convenience sample. Potential participants were recruited via a physician's office and a retail discount tobacco store in middle Tennessee. Smokers who volunteered to participate and signed an informed consent form smoked an average of 20.97 cigarettes per day (SD=10.39) and had been smoking for an average of 21,82 years (SD=12.57). Participants were treated in accordance with the ethical standards of the American Psychological Association, including the right to discontinue the study at anytime without penalty.

Instruments and Scale Measurement

An 18-item questionnaire published by NIH (1984) was utilized to assess smoker classification as smoking for habit (Cronbach's a=.71), stimulation (a=.85), handling cigarettes (a=.60), accentuation of pleasure or pleasurable relaxation (a=.64), reduction of negative feelings or "crutch" (a=.83), or craving or strong addiction (a=.72). Three questionnaire items were averaged to assess perceived control over smoking behavior (a=.81). Participants were also asked to estimate the likelihood (assessed as a percentage) of contracting coronary heart disease, lung cancer, and emphysema for themselves and for the typical smoker.

Procedure

The study protocol was approved via the senior author's university Institutional Review Board in Spring, 2001. Participants were identified from among patients registered at the office of a family practice physician, located in Hendersonville, Tennessee and customers of a discount tobacco store in Springfield, Tennessee. Participants who volunteered were informed that their answers would be utilized for research purposes only, were allowed as much time as necessary to complete the survey, and were allowed to discontinue participation at any time without penalty.

Coding and Scale Measurement

Within-participants independent variables were person being rated (either the participant or a typical smoker) and the disease (heart disease, lung cancer, or emphysema). The responses given in Section 1 of the questionnaire (see Appendix) were used to assign values to the six factors that influence smoking behavior (NIH, 1984): stimulation (sum of items 1,7, and 13); handling (2, 8, 14); relaxation (3, 9, 15); crutch (4, 10, 16); craving (5, 11, 17); and habit (6, 12, 18). These values were used, along with perceived control, number of years the participant had been a smoker, and number of cigarettes the participant smoked per day, as predictors of optimistic bias for each of the three diseases. Optimistic bias was operationalized as the difference between ratings of perceived likelihood of developing the diseases for the typical smoker and for the participant.

Results

Analysis of Covariance of Health Risks

The means and standard deviation of participants rating of health risks are reported in Table 1. A 3 (heart disease versus lung cancer versus emphysema) X 2 (rating a typical smoker versus rating self) within subjects analysis of covariance was performed on the subjects" perceived likelihood of developing disease, using perceived control as a covariate. There was a significant treatment effect for person being rated (typical smoker vs. self), F(1,94)=21.50, MSe=274.51, 12<.001, with the reported likelihood that a typical smoker would develop a disease being significantly higher than the reported likelihood of the participant developing a disease. The treatment effect for disease (heart disease vs. lung cancer vs. emphysema) was nonsignificant [F(2,188)=1.42, MSe=369.28, p>.05] as was the interaction between person being rated and disease [F(2,188)= 1.11, MSe=84.22, p>.05]. Perceived control was a nonsignificant covariate [F(1,93)=0.43, MSe=3116.45, 12>.05].

Multiple Linear Regression Analysis For Variables Predicting Optimistic Bias

Bivariate correlations of the study variables are reported in Table 2. A multiple linear regression analysis was performed using perceived control over smoking behavior (variable name Control), number of years the subject had been a smoker (Years), number of cigarettes the subject smoked per day (Cigspd), and the NIH factors influencing smoking behavior (Stim, Handle, Relax, Crutch, Craving, and Habit) to predict optimistic bias for heart disease (BiasHD), lung cancer (BiasLC), and emphysema (BiasEM). The backward elimination method was used to identify significant predictors of optimistic bias for each disease.

For heart disease, stimulation and pleasurable relaxation were found to be significant predictors of optimistic bias [R.=.29, F(2,91)=4.31, p<.02]. The best model for predicting the dependent measure is BiasHD=2.04 (Relax)--1.53 (Stim)--6.86. The proportion of variability uniquely explained by stimulation and pleasurable relaxation was determined by entering each variable as the last step of a hierarchical regression analysis. Stimulation uniquely explained 7.0% of the variability in optimistic bias, and relaxation uniquely explained 5.0% of the variability.

For lung cancer, the number of years the subject had been a smoker was found to be the only significant predictor of optimistic bias [R=.30, F(1.92)=8.77, p<.004]. The best model for predicting the dependent measure is BiasLC=-0.38(Years) + 15.84. Number of years uniquely explained 1.7% of the variability in optimistic bias.

For emphysema, the number of years the subject had been a smoker was also found to be the only significant predictor of optimistic bias [R=.22, F(1,92) = 4.74, p,<.04]. The best model for predicting the dependent measure is BiasEM= -0.31(Years) + 13.72. Number of years uniquely explained 1.4% of the variability in optimistic bias.

Discussion

As was hypothesized, the analysis of covariance showed that smokers do tend to be optimistically biased, rating health risks to themselves lower than to other smokers, regardless of the particular disease in question. This finding is consistent with the previous research on smoking and optimistic bias (Arnett, 2000; McCoy et al., 1992; Strecher, Kreuter, & Kobrin, 1995). However, the hypothesis that perceived control over smoking behavior would explain variance in optimistic bias among smokers was not supported.

The six factors identified by the NIH (1984) thought to influence smoking behavior also did not significantly explain variance in two of the optimistic bias measurements (i.e., lung cancer and emphysema) but did for optimistic bias related to heart disease. It is interesting that the two factors (i.e., stimulation and relaxation) that proved significant predictors of optimistic bias for heart disease are the two psychophysiological factors related to cardiovascular effects of smoking. The more biased smokers who smoke cigarettes for stimulation or relaxation may experience greater cardiovascular changes while smoking, thus leading them to bias their estimates of personal risk of heart disease. The current data do not allow us to make a strong assertion, but future research should examine the relationship between the NIH's stimulation and relaxation smoking factors and smokers' ability to tack psychophysiological changes (specifically cardiovascular changes) while smoking. It is possible that people who are more sensitive to increasing and decreasing heart rates will report greater optimistic bias for heart disease.

Additionally, the number of years that a person smoked significantly predicted their bias toward emphysema. While the percentage of explained variance was only 1.4%, it is worth noting that the longer a person smokes the greater their optimistic bias concerning emphysema. While preventing the onset of tobacco use remains the best prevention of smoking related illness (United States Department Health Human Services, 1994), messages targeting the detrimental health effects of smoking (i.e., increased probability of emphysema) may be most effective for motivating smoking cessation among neophyte smokers.

The purpose of this study was to identify factors that distinguish smokers with greater optimistic bias from smokers with less bias. It is still not clear what the explanation is for variability in optimistic bias to smoking related disease. The current data show that perceived control has little, if any, explanatory power of optimistic bias in smokers. The limited sampling frame from rural, middle Tennessee may explain why perceived control had no predictive utility for optimistic bias. It is possible that these results cannot be generalized to smokers in metropolitan geographic areas. Additionally, further research should employ qualitative research methods to examine possible underlying causes of optimistic bias among smokers. Additional research is necessary to fully examine the role that the NIH smoking factors play in the optimistic bias and successful cessation. Specifically, a survey of former smokers would provide an appropriate comparison group to current smokers for examining the influence of the NIH factors on successful smoking cessation.

Table 1

Perceived likelihood of Developing Disease (Percent)

                 Rating Typical Smoker        Rating Self

Disease            M       SD      n        M       SD      n

Heart Disease    54.16    24.29    95     49.32    28.80    95
Lung Cancer      57.90    25.02    95     50.43    27.36    95
Emphysema        54.48    25.86    95     47.49    28.57    95

Table 2
Intercorrelations Between Variables Predicting Optimistic Bias

                1       2       3       4       5       6       7

 1. Control     --     -.12    -.02    -.40     .16    -.19    -.08
 2. Habit               --      .43     .50     .25     .52     .36
 3. Stim                        --      .23     .40     .52     .39
 4. Craving                             --      .04     .58     .44
 5. Handle                                      --      .30     .34
 6. Crutch                                              --      .43
 7. Relax                                                       --
 8. BiasHD
 9. BiasLC
10. BiasEM
11. Cigspd
12. Years

                8       9       10      11      12

 1. Control     .12     .12     .12    -.48    -.23
 2. Habit      -.08    -.03    -.05     .40     .17
 3. Stim       -.19    -.10     .05     .15     .10
 4. Craving    -.01    -.04    -.03     .41     .16
 5. Handle      .11     .19     .03     .04    -.19
 6. Crutch      .02     .11     .08     .29    -.03
 7. Relax       .13     .10     .07     .22     .08
 8. BiasHD      --      .51     .34    -.04    -.17
 9. BiasLC              --      .45    -.11    -.30
10. BiasEM                      --     -.15    -.22
11. Cigspd                              --      .12
12. Years                                       --

Appendix

Smoking Belief Survey

Adam W. Waltenbaugh & Matthew J. Zagummy, Ph.D.

Partially modified from NIH Publication No. 84-1822

Note: By completing this survey, you are consenting that your answers may be grouped with similar data used for research purposes only

SECTION 1

Directions: Please respond to each of the statements by circling the
number which corresponds to your single answer.

                                        Never    Seldom    Occasionally

 1. I smoke cigarettes in order to        1        2            3
    keep myself from slowing down.
 2. Handling a cigarette is part of       1        2            3
    the enjoyment of smoking it.
 3. Smoking cigarettes is pleasant        1        2            3
    and relaxing.
 4. I light up a cigarette when I         1        2            3
    feel angry about something.
 5. When I have run out of                1        2            3
    cigarettes, I find it almost
    unbearable until I can get them
 6. I smoke cigarettes automatically      1        2            3
    without even being aware of it.
 7. I smoke cigarettes to stimulate       1        2            3
    me, to perk myself up.
 8. Part of the enjoyment of smoking      1        2            3
    a cigarette comes from the steps
    I take to light up.
 9. I find cigarettes pleasurable.        1        2            3
10. When I feel uncomfortable or          1        2            3
    upset about something. I light
    up a cigarette.
11. I am very much aware of the fact      1        2            3
    when I am not smoking a
    cigarette.
12. I light up a cigarette without        1        2            3
    realizing I still have one
    burning in the ashtray.
13. I smoke cigarettes to give me a        1        2            3
    "lift."
14. I enjoy watching the smoke as I       1        2            3
    exhale it.
15. I want a cigarette most when I        1        2            3
    am comfortable and relaxed.
16. When I feel "blue" or want to         1        2            3
    take my mind off cares and
    worries, I smoke cigarettes.
17. I get a real gnawing hunger for       1        2            3
    a cigarette when I haven't
    smoked for a while
18. I've found a cigarette in my          1        2            3
    mouth and didn't remember
    putting it there.

                                        Frequently    Always

 1. I smoke cigarettes in order to          4           5
    keep myself from slowing down.
 2. Handling a cigarette is part of         4           5
    the enjoyment of smoking it.

 3. Smoking cigarettes is pleasant          4           5
    and relaxing.
 4. I light up a cigarette when I           4           5
    feel angry about something.
 5. When I have run out of                  4           5
    cigarettes, I find it almost
    unbearable until I can get them
 6. I smoke cigarettes automatically        4           5
    without even being aware of it.
 7. I smoke cigarettes to stimulate         4           5
    me, to perk myself up.
 8. Part of the enjoyment of smoking        4           5
    a cigarette comes from the steps
    I take to light up.
 9. I find cigarettes pleasurable.          4           5
10. When I feel uncomfortable or            4           5
    upset about something. I light
    up a cigarette.
11. I am very much aware of the fact        4           5
    when I am not smoking a
    cigarette.
12. I light up a cigarette without          4           5
    realizing I still have one
    burning in the ashtray.
13. I smoke cigarettes to give me a          4           5
    "lift."
14. I enjoy watching the smoke as I         4           5
    exhale it.
15. I want a cigarette most when I          4           5
    am comfortable and relaxed.
16. When I feel "blue" or want to           4           5
    take my mind off cares and
    worries, I smoke cigarettes.
17. I get a real gnawing hunger for         4           5
    a cigarette when I haven't
    smoked for a while
18. I've found a cigarette in my            4           5
    mouth and didn't remember
    putting it there.

SECTION 2

Directions: Please respond to each of the statements by circling the
number which corresponds to your single answer.

                                       Strongly              Slightly
                                       Disagree   Disagree   Disagrees

1. I have control over my smoking         1          2           3
   behavior.
2. I don't have to have a cigarette.      1          2           3
3. I can easily quit smoking if I         1          2           3
   put my mind to it.
                                                          Strongly
                                       Slightly Agrees     Agree

1. I have control over my smoking             4              5
   behavior.
2. I don't have to have a cigarette.          4              5
3. I can easily quit smoking if I             4              5
   put my mind to it.

SECTION 3

Directions: Please answer each of the following questions to the best
of your knowledge, using a percentage value (0 - 100%) in each of the
blanks provided.

1. What do you think the chances are that a typical smoker will develop:
Heart Disease --%   Lung Cancer --%    Emphysema --%

2. What do you think the chances are the you will develop:
Heart Disease --%    Lung Cancer --% Emphysema --%

SECTION 4

Directions: Please answer each question by placing you answer in the
blank provided.

1. What is your age, in years? --
2. What is your gender? (M/F) --
3. What is your race? --
   1. African American
   2. Asian/Pacific Islander
   3. Hispanic
   4. Native American/Native Alaskan
   5. White
   6. Other
4. How many cigarettes per day do you smoke? --
5. How long have you smoked, in years? --

References

Arnett, J.J. (2000). Optimistic bias in adolescent and adult smokers and nonsmokers. Addictive Behaviors, 25 (4), 625-632.

Becker, M.H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2, 324-508.

Jenks, R.J. (1992). Attitudes, Perceptions, and Risk-Taking Behaviors of Smokers, Ex-Smokers, and Nonsmokers. The Journal of Social Psychology, 132 (5), 569-675.

Lichtenstein, E., & Glasgow, R.E. (1992). Smoking Cessation: What Have We Learned Over The Past Decade? Journal of Consulting and Clinical Psychology, 60(4), 518-527.

McCoy, S.B., Gibbons, F.X., Reis, T.J., Gerrard, M., Luus, C.A., & Sufka, A.V. (1992). Perceptions of Smoking Risk as a Function of Smoking Status. Journal of Behavioral Medicine, 15(5), 469-488.

McKenzie, J.F. & Smeltzer, J.L. (I 997). Planning, implementing, and evaluating health promotion programs: A primer. Boston: Allyn & Bacon.

National Institutes of Health. (1984). Why Do You Smoke? (NIH Publication No. 84-1822). Washington, DC: U.S. Government Printing Office.

Strecher, V.J., Kreuter, M.W., & Kobrin, S.C. (1995). Do Cigarette Smokers Have Unrealistic Perceptions of Their Heart Attack, Cancer, and Stroke Risks? Journal of Behavioral Medicine, 18(1), 45-54.

U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.

Weinstein, N.D. (1980). Unrealistic Optimism About Future Life Events. Journal of Personality and Social Psychology, 39(5), 806-820.

Weinstein, N.D. (1984). Why It Won't Happen to Me: Perceptions of Risk Factors and Susceptibility. Health Psychology, 3(5), 431-457.

Weinstein, N.D. (1987). Unrealistic Optimism About Susceptibility to Health Problems: Conclusions from a Community-Wide Sample. Journal of Behavioral Medicine, 10(5), 481-500.

Weinstein, N.D. (1988). The Precaution Adoption Process. Health Psychology, 7(4), 355-386.

ADAM W. WALTENBAUGH B.S

MATTHEW J. ZAGUMMY, Ph.D. *

Tennessee Technological University 

* Send all correspondence to: Dr. Matthew J. Zagummy, Department of Psychology, Box 5031, Cookeville, TN 48505