5. Discussion
In this study we find that many male smokers in China do
not think that smoking is a substantial threat to their personal health. However, such smokers do learn about this from the
adverse health experiences of a neighbor who experienced a
major smoking-related health shock, such as a diagnosis of lung
cancer or other smoking-related diseases. Most importantly, such
learning causes somemale smokers to increase their quitting intentions
and to actually quit.
We base our conclusion thatthe change in risk perceptions from
having had contact with new information in the form of learning
of a neighbor’s lung cancer diagnosis from data from a single
cross-sectional survey. The updating framework is dynamic in that
there is a prior that is updated based on receipt of new information.
Thus, ideally, we would have surveyed neighbors about their
risk perceptions immediately following a report that a neighbor
was diagnosed with lung cancer. Two years later, we would have
repeated the survey of the same persons, asking them about their
current risk perceptions.
However, this quasi-prospective survey approach is impractical.
For one, many months, if not years, may have elapsed from the
date of the diagnosis to the time the information is available for
survey research. Even though the probability of getting lung cancer
is substantially increased by smoking over the life course, the
probability of getting lung cancer in a year is low. Thus, to locate
a sufficient number of smokers who are subsequently diagnosed
with lung cancer at a particular point in time, a large number of
smokers would have to be surveyed. For this reason alone, the cost
of a fully prospective study of risk perception updating would be
prohibitively high. Compared to this type of prospective approach,
our cross sectional survey approach coupled with cross checks we
undertake is efficient.
There are many health risks of smoking. Why did we focus on
lung cancer? The reason we focused on the risk of lung cancer
but not other smoking-related disease is not only because that the
odds of getting lung cancer from smoking is relatively high, but
there is greater awareness of the lung cancer risk than of other
health risks. In our survey, 72 percent of smokers knew that smoking
causes lung cancer but awareness of other smoking-related
risks was much lower. Also, the adverse consequences of being
diagnosed with lung cancer tend to occur relatively quickly following
the diagnosis, e.g., relative to diagnosis of heart disease. So
learning of a neighbor being diagnosed with lung cancer is likely to
have a relatively greater effect on risk perceptions of the harms of
smoking than other smoking related diseases.
Smoking is widespread among men in middle- and low-income
countries and among men in China and other countries in the
East Asian and Pacific region in particular. There is some empirical
evidence that public advertising of health harms of smoking has
not succeeded in reducing smoking prevalence in these countries
(Nelson, 2003). Moreover, with the high proportion of physician
smokers in China, it is difficult to see how individual counseling
of patient smokers by physicians could be very effective (Li et al.,
2007).
General information about the health harms of smoking may
be ineffective because it is insufficiently personalized (Sloan et al.,
2003). Smokers may reason that while the public messages are valid
on average, they believe that they personally are less susceptible
to smoking-related diseases and hence general messages do not
apply to them. Or people do not listen to results for the population
in general. Partly for these reasons, news media often seek personal
stories to which individual readers can relate.