Co-author of "Smoking: Risk, Perception, and Policy," Research Director of the Institute for Adolescent Risk Communication
Rendez-vous with . . . Dan Romer
Annenberg Public Policy Center
University of Pennsylvania
Philadelphia, Pennsylvania, USA
By Philippe Boucher
Monday, August 13 2001
PB : Thank you Dan for accepting our rendez-vous.
May I ask you to introduce yourself ?
Dan Romer: I am Research Director of the Institute for Adolescent Risk Communication at
the Annenberg Public Policy Center, University of Pennsylvania. I am a social psychologist who studies adolescent risk behavior with particular interest in mass media influences. Tobacco use is a long-standing concern among health researchers because it affects so many people and is the leading preventable cause of premature death in this country. I and my co-author at the Policy Center, Patrick Jamieson, became interested in tobacco risk perceptions a few years ago when we first saw the arguments coming from the industry in response to the efforts of the FDA to restrict tobacco advertising and to treat cigarettes as a drug delivery mechanism. The industry countered that restricting advertising was not only unconstitutional but that there was no need for further restrictions because smokers knew the risks and were free to make up their own minds about the benefits of smoking. These same arguments were being used in response to class-action lawsuits brought by smokers and by the States to recover costs of tobacco related illnesses.
An important part of the industry argument was research conducted by Kip Viscusi, an economist at Harvard Law School, who used industry collected data to make the case that when asked, smokers saw cigarettes as far more likely to produce lung cancer than was the case and that young people were especially prone to over-estimate cigarette risks. He argued that young people, who are the ones who first start smoking, were well informed about the risk and that the market for this potentially hazardous product was working well.
We were not convinced that this argument was valid, and so we conducted a national survey in 1999 to get our own data on adolescent risk perceptions regarding tobacco. This research convinced us that Viscusi was misled by his data, and it led us to team up with Paul Slovic, an expert in risk perception, to conduct a much larger and complete survey late in 1999 and into 2000 to examine how young people interpret risk assessment questions and how their assessments influence their decisions to start smoking. This work as well as the first survey is reported in the book: "Smoking: Risk, Perception, and Policy," edited by Paul Slovic (Sage Press). Another part of the story is published in the Journal of Adolescent Health in an article entitled: "Do Adolescents Appreciate the Risks of Smoking? Evidence from a National Survey," in the July 2001 issue.
Q1. As I just finished reading Smoking, Risk, Perception and Policy, there were several press articles unrelated to the book about those issues. One was titled: the number one big lie of the tobacco industry, everybody knows! *
Was that the main reason for publishing the book?
DR: Yes. The industry argues that with all the health warnings on cigarette packs and other efforts in the schools and the media, young people are adequately informed. But just as the doctor says in the article to which you refer, most people do not have the kind of understanding that will prevent them from trying smoking and young people do not fully understand the hazards, especially how hard it will be to quit once they have started.
Q2. You designed two extensive surveys to improve our understanding of how people (young and adults) deal with the risks they associate (or not) with smoking. What do you consider the key findings to recall?
DR: The key findings are that just in terms of knowledge of the risks of smoking, most young people are aware of lung cancer and that's it. There are a multitude of other illnesses attributable to smoking that young people have no knowledge about. In addition, a large proportion of young smokers (about 30%) do not know that smoking cuts short one's life and of those who do, 49% underestimate by how much (7 years on average). Although the industry says that young smokers know that smoking is addictive, we found that they really don't have a full appreciation of what that means. Of the 80% who claim to know that cigarettes are addictive, about 60% still think that they could quit with little trouble. So, the potential for addiction is not a barrier to trying smoking. Finally, we found that cigarette industry advertising (through its positive imagery of the healthy and relaxed smoker) promotes positive feelings about smoking among young people, and this reduces their perceptions of risk while it encourages smoking initiation.
Q3. Another key predicament of the industry is that advertising does not induce young people to start smoking. Is the reality different?
DR: We found that advertising is related to young people's initiation of smoking. The positive imagery leads to favorable feelings about smoking and these encourage trial and a favorable reaction from one's peers. The industry spends about $8 billion a year on advertising and promotion. It is hard to believe that this presence does not have an influence on young people. We found that they have the highest awareness of ads of all age groups. In addition, counter-advertising and education which only total about $1 billion annually, have less reach and are less effective (with some notable exceptions) than the industry effort.
Q4. New studies seem to show that women smokers would be much more at risk than male smokers. Until now the differences were mostly focused about smoking during pregnancy and smoking while taking birth control pills. If the new findings are confirmed, how do you think such new risks could/should be conveyed and did your surveys show differences in the risks perception according to the gender? (Do girls and women perceive the risks differently than boys and men?)
DR: We did not find large gender differences in risk perception. In order to convince young women that smoking is hazardous to their health, we will need messages that have an emotional as well as informational effect. The warnings we currently have on cigarette packs may not get the message across. In Canada, they have just introduced warnings on cigarette packs with color pictures of pregnant women that say: "Tobacco use during pregnancy reduces the growth of babies during pregnancy. These smaller babies may not catch up in growth after birth and the risks of infant illness, disability and death are increased." We may need messages like this, and we will soon conduct tests to see if this kind of more explicit message (with pictures) will do a better job of making the risk more emotionally meaningful.
Q5. . So what? What should be done so that smokers have an adequate perception of the risks associated with smoking? What would an adequate perception be? The book states at the end that "agressive measures are needed" (p.282) but I did not find them that aggressive at all. As you report on the back cover, the industry spent $8.24 billion promoting smoking in 1999 and how much did the opposition invest?Last but not least does the Annenberg School for Communication have new
programs about/against smoking on the way?
DR: We need more effort to counter industry advertising. Currently, the States are spending far too little of the money they get from the Master Settlement Agreement to support counter-advertising and other measures. Our Institute will test better warnings for cigarette packs like the ones used in Canada. We will also soon test a program in a smaller market that is directed to teens and that will try various approaches to make the message emotionally lasting.
Q6. Is there anything else you would like to add?
DR : I've said a lot...
PB: Thank you Dan for taking the time to be with us today.
* This article, by Gilbert Ross, was published on August 2 in the Los Angeles Times
Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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