Book Review

Smoking: Risk Perception & Policy, Paul Slovic, Editor

Reviewed by Herbert H. Severson, PhD

Experts generally acknowledge that the majority of cigarette smokers begin use during their teen years, and tobacco companies have focused their marketing efforts at attracting young people to try their products. An important aspect of this marketing effort is to make the product attractive while concealing the risks to the users. In recent years, we have come to a better understanding of the ways in which young people perceive the risks of smoking. With collaboration and support from the Annenberg School of Communication and Public Policy Center at the University of Pennsylvania, Paul Slovic has compiled the most objective, thorough, and authoritative research on the question of whether young people fully understand the consequences of their decision to smoke cigarettes.

The Industry has used an influential book by economist Kip Viscusi (1992) to promote the idea that “when individuals initiate their smoking activity, they understand the consequences of their decision and make rationale decisions” (p.11). Viscusi argued that these data support a rational learning model on which consumers make trade offs between the risks and benefits of smoking. Smoking: Risk Perception & Policy strongly rebuts this argument, and provides a strong empirical and theoretical basis for the role of risk perception in both initiation and progression toward regular tobacco use.

The initial chapter provides a review of the risks of active and passive smoking by Jonathan Samet, and describes the methodology of the survey research conducted by the authors (primarily Slovic, Neil Weinstein, Patrick Jamieson, and Daniel Romer). The authors surveyed over 2,300 US young adults aged 14-22 (including almost 500 smokers), and 1,500 people over age 23 (including 310 current smokers). In addition to the careful analysis of their survey data, the authors bring together a long history of research on decision-making, and apply this work to smoking initiation.

In Chapter 4, Romer and Jamieson explore the role of risk perception in the initiation of smoking and progression towards regular tobacco use. The authors conclude that heightened perceptions of risk do not deter young people from starting to smoke. Perceived health risks play a greater role for adult smokers and their decisions to stop smoking. The analysis confirms the central role of affect/feelings in determining risk perception. Positive images and feelings are associated with lower risk perceptions and the belief that quitting will be easy. Romer and Jamieson assert that the decision to smoke appears driven primarily by the degree to which feelings or attitudes towards smoking are positive.

Slovic and his colleagues have argued for an “affect heuristic” in which a person’s perceptions contain affect, and this relatively automatic process greatly influences our decisions largely without our awareness. The authors assert that affect plays a central role in a dual process of thinking, in which people apprehend reality in both an analytical, deliberative way and an automatic experiential way. Slovic et al. present an empirical basis for how subtle affective cues or conditioning induce our preferences, and that, when faced with ambiguous situations, we depend more upon our intuitive and conditioned automatic responses. In addition, the authors report an inverse relationship between perceived risk and perceived benefit; ergo, if we perceive the benefit to be high, then we will judge the risk low. Their research shows that beginning smokers fail to appreciate the risks of smoking and underestimate the difficulty in quitting.

Smoking: Risk Perception & Policy provides a wealth of information varying from “A Visceral Account of Addiction” by George Lowenstein, to a discussion of the failure of Economic Theory and legal regulation as it pertains to tobacco control (Jon Hanson & Douglas Kysar). Hanson and Kysar’s account of documented marketing activities by the tobacco industry provides additional support for Slovic’s conclusion that advertising and marketing targeted to young people is designed to generate positive affect for cigarettes by emphasizing positive images of smokers. The authors provide a compelling argument for policymakers to take seriously the problems of market manipulation by tobacco manufacturers. Finally, Richard Bonnie, co-editor of the Institute of Medicine (IOM) Report, “Growing Up Tobacco Free” (Lynch & Bonnie, 1994), reviews the recommendations contained in the IOM for the development of public health policies on tobacco, with a focus on preventing youth from becoming addicted.

In sum, I highly recommend this book as it provides a concise analysis of how our perceptions of risk influence smoking behavior. Strengths of the book are the coherent structure and development of chapters, which provide support for the central thesis. Smoking: Risk Perception & Policy is a major contribution to our understanding of both the onset of tobacco use and the marketing that maintains the tobacco industry.

-- Herbert H. Severson is a Senior Scientist at Oregon Research Institute in Eugene, OR.