Jean Constance

Smoking too few cigarettes to be at risk? Smokers’ perceptions of risk and risk denial, a French survey

Background: Past studies on smokers’ risk perception have produced mixed results. We endorsed a new approach to assess smokers’ perceptions of risk by asking them to estimate threshold values for the cancer risk associated with daily consumption of tobacco and number of smoking years. We expected that many smokers would endorse a “risk denial” attitude, with threshold estimates higher than their own smoking consumption and duration. Methodology: A French national telephone survey (n = 3820; 979 current smokers) included several questions about smoking behaviours and related beliefs. Results: Among current smokers, 44% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 20% considered that the cancer risk becomes high only for a smoking duration higher than their own. Most smokers also agreed with other “risk denial” statements (“smoking is not more dangerous than air pollution,” “some people smoke their whole life but never get sick”). Those who considered they smoked too few cigarettes to be at risk were less likely to report personal fear of smoking related cancer. Conclusion: Risk denial is quite widespread among smokers and does not simply reflect a lack of information about health risks related to tobacco. Fully informing smokers about their risks may necessitate changing the way they process information to produce beliefs and limiting their capacity to generate self exempting beliefs.

“It’s All We Got Left”. Why Poor Smokers are Less Sensitive to Cigarette Price Increases

In France, between 2000 and 2008, concurrently to the increase in cigarette price, we observed an increasing social differentiation of cigarette smoking: smoking prevalence decreased among executive managers and professional occupations, it remained stable among manual workers, and it increased among the unemployed. Poor smokers were heavier smokers, they were more frequently tobacco-dependent, and they were more prone to smoke automatically or to reduce “negative feelings”. In-depth interviews provided a more comprehensive insight into poor smokers’ motivations: they were aware of their addiction, but they also talked about the pleasure they get from smoking, and they highlighted the essential needs satisfied by smoking: stress relief, cheap leisure, compensation for loneliness, break-up or redundancy… Acknowledging the functional aspects of smoking experienced by poor smokers helps to understand why increasing the cigarette price is unlikely to deter many poor smokers from smoking.

Working conditions, job dissatisfaction and smoking behaviours among French clerks and manual workers.

Objective: To study the relationships between working conditions, job dissatisfaction and smoking behaviors among clerks and manual workers. Methods: We used data from the French Health Barometer, a cross-sectional telephone survey conducted among a national random sample (N = 4825). Regarding working conditions, the questionnaire dealt with reported job satisfaction, psychological demands and mental workload, physical demands, latitude decision and work schedule. Results: Manual workers and clerks who reported strong dissatisfaction toward unhealthy working conditions also reported more frequently current smoking, tobacco dependence, potential alcohol dependence and perceived stress. After adjusting for socio-demographic confounders, perceived working conditions and job dissatisfaction remained correlated with smoking and tobacco dependence. Conclusions: Poor working conditions may heavily contribute to health inequalities, as they are likely to fuel both stress and unhealthy behaviors, which combine to increase morbidity and mortality.