Perceptions of the Risks from Smoking and Smokeless Tobacco Use

University faculty perceptions of the health risks related to cigarettes and smokeless tobacco . Published in Drug and Alcohol Review (Volume 29, pages 121-130, 2010) by Nicholas Peiper, Ramona Stone, Riaan van Zyl and Brad Rodu. (UofL)

Consider an American addiction: automobile travel.  Driving around town or around the country, we recognize and accept a small but measurable risk of dying in an accident. We take comfort in the fact that our cars’ seat belts and airbags will protect us. 

Now imagine a world in which the American Automobile Association, the Fraternal Order of Police and the National Highway Traffic Safety Administration declared that cars with seat belts and airbags are just as dangerous as cars without these devices, and that the only way to avoid dying in an auto accident was to avoid automobiles altogether.

This is an outrageous scenario. We wouldn’t tolerate the dissemination of such demonstrably false information by non-profit groups, professional organizations and government agencies. It is well established that these harm reduction measures (seat belts and airbags) have helped reduce automobile accident deaths to record-low numbers (34,000 in 2009). 

So why do we tolerate misinformation about smokeless tobacco, a harm reduction measure for smokers that could prevent over 400,000 deaths per year?

In 2009 we published a study documenting that misinformation about the risks of smokeless tobacco use has led to widespread misperception among highly educated university faculty, even those in health-related schools.  The first author of our study was Nicholas Peiper, a doctoral student in epidemiology at the University of Louisville.  Ramona Stone and Riaan van Zyl of the U of L Kent School of Social Work were our collaborators. 

We conducted a survey that quantified the risk perceptions of cigarette smoking and smokeless tobacco use with respect to general health, heart attack/stroke, all cancer, and oral cancer among full-time faculty.  We compared the results from faculty on the health science campus with those in schools not related to health. 

We found that misperception was common among this highly educated group.  For example, 51% of all faculty incorrectly believe that smokeless tobacco use confers general health risks that are equal to or greater than smoking.  The misperception rate was lower for heart attack/stroke risk (33%) but higher for cancer (61%). 

The misperception rate for oral cancer was stunning: 86% of all faculty incorrectly believe that smokeless tobacco use confers risks that are equal to or greater than smoking.  Although faculty on the health science campus had a somewhat lower rate than others (81% vs. 91%), our survey provides evidence that most health professionals have a poor understanding that smokeless tobacco use is vastly safer than smoking.