APPENDIX 6
Memorandum by the Consumers' Association
(TB 10)
EXECUTIVE SUMMARY
More than three-quarters of the population are
regularly exposed to other people's smoke at home, work and in
social situations. Consumers' Association (CA) research into consumer
views about smoking shows that many people are dissatisfied with
this exposure—particularly in social situations or within
the work environment. This research also highlights the problem
that people face in environments that they have little or no control
over, and in the case of the work environment, no realistic choice
about exposure to other people's smoke.
Our research found that most people are aware
that smoking carries health risks but that awareness of links
between smoking and some health problems, particularly heart conditions,
is low. Most people also recognise that there are health risks
associated with passive smoking, though many smokers still refute
that there is a connection between ill health and passive smoke.
Overall, there are significant differences between how smokers
and non-smokers perceive health risks and our research suggests
that smokers have more readily accepted the risks that smoking
poses to their own health than the problems that their smoke may
cause for others.
This research also found that there are gaps
in awareness about the links between parental or passive smoking
and the health implications for babies and children. While awareness
of the link between smoking and some childhood disease, for example,
asthma, is relatively high, many people are unaware of the link
between smoking and other health problems, including glue ear.
However, there is very broad support for the idea that smokers
have responsibilities when it comes to babies and children. The
majority of our respondents—smokers and non-smokers alike—said
that they believe that people should not smoke near babies or
children.
There is also a high level of support for government
intervention on tobacco, particularly in relation to protecting
young people and children. Most people—including half of
the smokers who participated in this research believe that the
government should do more to discourage smoking. We found that
a considerable number of respondents, both smokers and non-smokers,
would be in favour of raising the legal age of smoking to 18.
It is likely that the controversy over proposals
to protect consumers from the effects of smoking and passive smoking
will continue for some time. However, CA research shows that there
is considerable support, even if some smokers remain opposed,
for government action in this area—and that some measures
in the fight against smoking and smoking related disease may command
more public support than others. Measures to protect children
and young people and to increase access to smoke free environments
may be viewed as particularly acceptable.
However, this research also shows that there
is still a long way to go before the public fully understand the
health risks associated with smoking and passive smoking and,
importantly, that there are quite significant differences in how
smokers and non-smokers perceive these risks. This would suggest
that in addition to practical restrictions on smoking, there is
a need for health education measures to fill the awareness gap.
INTRODUCTION
1. Consumers' Association (CA) is an independent
consumer organisation with a membership of over 700,000. CA's
sole aim is to achieve improvements in goods and services on behalf
of consumers and to ensure that consumers have access to the information
they need to make informed decisions.
2. CA is probably best known for its consumer
reports published in Health Which?, Which?, Holiday Which? and
Gardening Which?. However, CA reaches more specialist audiences
through publication of Drug and Therapeutics Bulletin (DTB) and
Consumer Policy Review (CPR). DTB provides independent and rigorous
evaluations of drugs and other treatments and is circulated monthly
to over 115,000 doctors and pharmacists. CPR is published bi-monthly
and aims to promote debate and discussion across a wide range
of consumer policy issues.
OUR EVIDENCE
3. CA has considered the terms of reference
for the inquiry into smoking which are as follows: The Committee
will examine what action the tobacco industry has taken, and is
currently taking, in response to the scientific knowledge of the
harmful effects of smoking and the addictive nature of nicotine.
It will also look assess the role of government in providing consumer
protection.
4. Although CA has not looked at the actions
of the tobacco industry, we have completed a significant piece
of research into consumer perceptions and attitudes towards smoking
and passive smoking in particular. We believe that this research
provides important insights into smoking related behaviour which
could be useful to the Committee in its review of the role of
government in providing consumer protection. Some of the results
of this research have been published in Health Which?[6]and
Consumer Policy Review[7]which
are attached for your information.
CURRENT CONTEXT
5. The health risks of smoking are widely
accepted and there is increasing awareness of the link between
health problems and smoking. The government has acknowledged that
smoking is a key health issue and in the last year has made a
firm commitment to reduce smoking and smoking related disease
both in the Smoking Kills[8]and
in the Saving Lives, Our Healthier Nation,[9]White
Papers.
6. However, in order to be effective, the
government's strategy must command broad public support and specific
measures to reduce smoking must be based on a good understanding
of how people understand and respond to information about risk
factors. It was with this in mind that CA undertook research into
public perceptions about, and attitudes towards, smoking.
CONSUMERS' ASSOCIATION
RESEARCH
7. In August 1998, Consumers' Association carried
out research into consumer views about smoking and passive smoking.
The general objective was to:
— determine what percentage of the
population smokes cigarettes; how many have given up the habit
or have never smoked;
— determine how many of smokers and
non-smokers are exposed to passive smoke at work, at home or in
other social environments;
— examine the level of awareness and
understanding about the health risks of smoking and passive smoking,
specifically what diseases people believe are caused by smoking
and by passive smoking;
— examine experiences with specific
health problems;
— explore whether negative attitudes
are associated with perception of health risks;
— determine the perceived risks of
passive smoking for children or unborn babies;
— explore attitudes towards smoking
in the home, at work and in social situation.
8. Face-to-face home interviews as part of an
Omnibus survey—which uses a random cross-section of the
population were conducted by BMRB between 20 and 26 August 1998.[10]The
Omnibus achieved a sample of 988 adults aged 16 or over across
Great Britain. Adults employed by the tobacco industry or in the
medical profession were excluded. The small number of non-cigarette
smokers who smoked cigars and pipes were also excluded. The resulting
sample totalled 927. This section describes the outcome of the
research grouped into four key areas:
— attitudes to smoking, passive smoking
and health (including awareness of risks);
— attitudes to smoking and passive
smoking, including smokers' responsibilities to others;
— attitudes to government intervention.
EXPOSURE TO
SMOKE: SMOKERS,
NON SMOKERS,
EX-SMOKERS
AND PASSIVE
SMOKERS
9. In the survey, 67 per cent of respondents
did not smoke and 33 per cent smoked cigarettes (having excluded
the small number who did not smoke cigarettes but did smoke pipes
or cigars). Of the non-smokers, 61per cent had never smoked and
39 per cent were ex-smokers who had given up.
10. There was very little difference in
prevalence of smoking between women and men. People aged between
15-44, particularly the 25-34 year-old age group, were most likely
to smoke. People in socio-economic groups D and E were more likely
to smoke than those in the AB socio-economic groups. The proportion
of smokers to non-smokers in groups C1 and C2 is very close to
the national average of 33 per cent to 67 per cent.
11. The majority of smokers had smoked for
a long time. 47 per cent of smokers had been smoking for over
20 years and 27 per cent had been smoking for between 10 and 20
years. Only two per cent had been smoking for up to one year.
Of the smokers, 36 per cent were light smokers (10 or less cigarettes
per day), 47 per cent were moderate smokers (between 11 and 20
cigarettes per day) and 16 per cent were heavy smokers who smoked
21 or more per day.
12. Of those who had given up smoking, the
majority (59 per cent) had given up for more than 10 years. A
third had given up over 20 years ago, and a quarter had given
up between 10 and 20 years ago. Within the last year, eight per
cent had given up.
13. Many people said that they were exposed
to smoke through their partner. Of the two-thirds of respondents
who did have a partner, 35 per cent had a partner who smoked cigarettes.
Respondents were asked whether other people regularly smoke around
them in a range of places, such as their home, place of work or
places that they visit socially. In total, three quarters of respondents
were exposed to passive smoke in at least one of the places. On
average these respondents were exposed to passive smoking in two
different locations.
14. Places visited socially were the most
common source of exposure to passive smoke (60 per cent). A third
(33 per cent) of respondents were exposed to smoke in their homes,
a fifth (20 per cent) in their place of work and 14 per cent while
travelling for work or pleasure. The last two categories are those
where exposure to smoke is most likely to be involuntarily.
SMOKING, PASSIVE
SMOKING AND
HEALTH
15. Personal experience of smoking related
health problems was explored—people were asked whether they,
their children, or an adult relative or close friend, suffered
any of a range of smoking-related diseases. General attitudes
to the link between passive smoking and health risks were assessed.
Knowledge of diseases associated with smoking and passive smoking
was explored with both spontaneous and prompted questions. Respondents
were also asked about specific effects of passive smoking on children.
Smoking and health: Personal experience
16. Respondents were asked about whether
they, their children, an adult relative or a close friend had
suffered from a range of medical conditions: bronchitis, asthma,
heart disease/attacks/angina, strokes, lung cancer, mouth or throat
cancer or emphysema. Almost three-quarters of respondents had
not suffered from any of these smoking-related conditions. The
most common conditions were bronchitis (15 per cent) and asthma
(11 per cent) followed by 6 per cent suffering from heart disease,
heart attacks or angina. Seven out of 10 in the sample, however,
knew an adult relative or close friend who had suffered from one
of these conditions. Most commonly, heart disease, heart attacks
or angina (33 per cent), asthma (27 per cent), strokes (20 per
cent), bronchitis (17 per cent) and lung cancer (17 per cent).
17. People with children under 16 (53 per
cent) were asked whether their children had suffered any of the
following problems: asthma, chest infections, bronchitis, and
other infections, low birth weight or glue ear. Fifty-nine per
cent of respondents with children said that none had suffered
any of these problems. Of those whose children did have problems,
a fifth (21 per cent) had children who suffered from asthma, 13
per cent had chest infections, 8 per cent other infections, 7
per cent were born with a low birth weight and 5 per cent suffered
from glue ear.
Attitudes to passive smoking and health
18. Most people did recognise that passive
smoking carries a health risk—over two-thirds disagreed
(either strongly or slightly) with the statement "I don't
think passive smoking is a serious health risk". There was
considerable difference between smokers and non-smokers on this
issue. Although three-quarters (76 per cent) of non-smokers disagreed
with the statement and said that they believed that smoking is
a serious health risk, only just over half of smokers (51 per
cent) disagreed.
19. Analysis by the amount smoked revealed
that light smokers are much more likely to see passive smoking
as a serious health risk than medium or heavy smokers. While 54
per cent of people who smoke less than 10 cigarettes per day think
that passive smoking is a serious health risk, only 43 per cent
of those smoking 20 or more a day think so.
20. More than six out of 10 (63 per cent)
disagreed with the statement "I am more bothered about the
smell of cigarettes than the health risk" including over
half of smokers (51 per cent) and two-thirds of non-smokers (68
per cent). Although this question related to attitudes to the
smell of tobacco as well as risk perception, it does confirm a
high level of general awareness about the health risks of tobacco
and of passive smoking.
21. Although most people—including
over half of smokers—do recognise that passive smoking carries
health risks, there are substantial numbers who do not believe
in the connection or are uncertain. A quarter of respondents refute
the connection, rising to over a third (36 per cent) of smokers.
In addition, 39 per cent of respondents agreed with the statement
that "Pollution is so bad these days, passive smoking makes
no difference". The statement was disagreed with by 46 per
cent of respondents and 14 per cent were neutral.
22. Once again, smokers were more likely
to agree with this statement than non-smokers—58 per cent
of smokers agreed with the statement compared to 30 per cent of
non-smokers. Conversely, 57 per cent of non-smokers disagreed
with the statement compared to 24 per cent of smokers. Heavy smokers
are most likely to agree and least likely to disagree that "pollution
is so bad these days, passive smoking makes no difference".
23. A degree of scepticism about health
advice can be inferred from the fact that 58 per cent agreed with
the sentiment that "everything is bad for you these days".
Not surprisingly, smokers were more likely to agree and less likely
to disagree with this statement. While over half of non-smokers
(51 per cent) agreed with the statement, this rose to 73 per cent
in smokers.
Awareness of risks associated with smoking and
passive smoking—unprompted responses
24. Respondents were asked if they believed
that smoking could cause or aggravate certain diseases or conditions
and if so, which? It is clear that lung cancer is the medical
condition most commonly associated with both smoking and passive
smoking. Awareness of the link between lung cancer and smoking
is high with 75 per cent citing it spontaneously—although
awareness or acceptance of the link is much lower for passive
smoking (58 per cent).
25. The next most commonly cited disease
for both smoking and passive smoking was asthma (51 per cent and
49 per cent respectively). For these diseases, along with emphysema
and glue ear, there appears to be relatively little differentiation
between the link with smoking and the link with passive smoking
(compared to the 17 per cent difference for lung cancer). This
might suggest that some respondents doubt the validity of the
claimed link between passive smoking and lung cancer.
26. Spontaneous awareness of the link between
heart disease and smoking or passive smoking was low. Only just
over a third spontaneously cited heart disease, heart attacks
or angina as being affected by smoking. This dropped to 23 per
cent in connection with passive smoking. This low awareness is
in contrast to the reality, smoking is said to cause one in five
heart disease deaths, and heart disease is the biggest single
cause of death in the UK.
Awareness of risks associated with smoking and
passive smoking—prompted responses
27. Respondents were asked whether smoking
or passive smoking increased the risk of developing any of a list
of specific conditions, some of which are totally unrelated to
smoking:
| Strokes | Epilepsy
| Anaemia |
| Glandular Fever | Lung Cancer
| Heart disease/attacks or angina
|
| Asthma | Mouth and Throat Cancer
| Hepatitis |
| Rheumatoid Arthritis | Haemophilia
| Prostate Cancer |
| Bronchitis | Emphysema |
Malaria |
28. Most people recognised the diseases caused by smoking
when prompted. Awareness of lung cancer rose to 95 per cent, bronchitis
to 93 per cent and mouth and throat cancer (relatively low in
the spontaneous awareness question) rose to 92 per cent. Similarly
the risk of heart disease, mentioned spontaneously by only 34
per cent was considered to be increased by smoking by almost nine
out of 10 when prompted.
29. When asked about the same conditions and passive
smoking, awareness rose similarly. Awareness of the role of passive
smoking and lung cancer rose to three-quarters (75 per cent),
asthma to 74 per cent bronchitis to 73 per cent and mouth or throat
cancer to 56 per cent. Although awareness of the role of passive
smoking in heart disease rose dramatically to 58 per cent, this
is still relatively low compared to lung cancer and bronchitis.
30. Diseases unrelated to smoking or passive smoking
were recognised by most respondents with the notable exception
of prostate cancer. There appeared to be particular confusion
about whether there is any link between prostate cancer and smoking—with
35 per cent believing that smoking does increase the risk of developing
prostate cancer and 18 per cent believing that passive smoking
increases the risk. It may be that smoking has become closely
linked in public perception with the generic term "cancer"
hence this mistaken attribution of a link between tobacco and
prostate cancer.
31. Despite the fact that relatively few people wrongly
ascribed a link between smoking and most of the diseases unrelated
to smoking on the list, there were some signs of confusion—with
around 20 per cent of people responding "don't know".
Differences between smokers and non-smokers
32. When the risk perception results were compared between
smokers and non-smokers some differences were apparent. Smokers
are less likely to recognise the connection between smoking or
passive smoking and the known smoking-related diseases than non-smokers.
Table 1
PERCENTAGE OF RESPONDENTS BELIEVING THAT SMOKING CAN CAUSE
OR AGGRAVATE THESE DISEASES
|
| (Prompted Response)
|
| Total
| Smokers | Non-Smokers
|
| %
| % | %
|
|
| Lung Cancer | 95
| 93 | 97
|
| Asthma | 89
| 84 | 91
|
| Bronchitis | 93
| 91 | 94
|
| Heart disease | 89
| 88 | 89
|
| Mouth or throat cancer | 92
| 87 | 94
|
| Emphysema | 64
| 87 | 65
|
| Strokes | 66
| 61 | 67
|
|
33. Our research found that non-smokers are more likely
to believe that passive smoking is linked to the health problems
listed. However, the gap is larger than it is in relation to smoking
and these diseases—with differences of between 10 and 19
percentage points. This could suggest that smokers awareness of
the risks to their own health from smoking is greater than their
awareness—or acceptance—of the risks to others from
breathing other peoples smoke. The non-smokers, however, are not
necessarily always more accurate in their perception of risks—emphysema
and mouth or throat cancer have yet to be scientifically linked
to passive smoking.
Table 2
PERCENTAGE BELIEVING THAT PASSIVE SMOKING CAN CAUSE OR
AGGRAVATE THESE DISEASES
|
| (Prompted Response)
|
| Total
| Smokers | Non-Smokers
|
| %
| % | %
|
|
| Lung Cancer | 75
| 65 | 80
|
| Asthma | 74
| 67 | 78
|
| Bronchitis | 73
| 65 | 77
|
| Heart disease | 58
| 49 | 63
|
| Mouth or throat cancer | 56
| 43 | 62
|
| Emphysema | 45
| 38 | 48
|
| Strokes | 3
| 24 | 37
|
|
Awareness of Risks—Child Health and Passive Smoking
34. People's awareness of the risks of passive smoking
for children were explored. Respondents were asked whether passive
smoking increases a child's risk of developing a number of medical
conditions—all medically linked to passive smoking. See
Table 3.
Table 3
WHETHER PASSIVE SMOKING INCREASES A CHILD'S RISK OF DEVELOPING
THIS DISEASE
|
| Yes | No(%)
| Don't Know(%) |
|
| Total(%)
| Smokers(%) | Non-Smokers(%)
| | |
|
| Asthma | 89 |
83 | 92
| 7 | 3
|
| Chest infections | 89
| 85 | 91
| 7 | 4
|
| Bronchitis | 88
| 84 | 91
| 7 | 4
|
| Glue Ear | 11
| 12 | 11
| 56 | 33
|
| Diabetes | 10
| 8 | 11
| 74 | 16
|
|
35. Awareness of the risks to children's health was very
high in relation to asthma, chest infections and bronchitis—at
almost nine out of 10. Yet, awareness of the links to glue ear
and diabetes was very low—at around one in 10. There appeared
to be considerable confusion about these conditions—particularly
glue ear—as shown by the high proportions of "don't
know" responses (33 per cent and 16 per cent respectively).
36. Once again, and notsurprisingly, there were differences
between smokers and non-smokers—with non-smokers more likely
to recognise the links between passive smoking and the top three
conditions (asthma, chest infections and bronchitis) but with
very similar results for glue ear and diabetes, where uncertainty
was common.
37. Further analysis of the perception of risks to children
from passive smoking revealed differences depending on exposure
to other people's smoke. Those who were exposed to passive smoke
at work—where the exposure is most likely to be involuntary—were
slightly more likely to believe in the link between passive smoking
and childhood chest infections or bronchitis.
38. Awareness of health risks for a baby if its mother
smokes during pregnancy is high. Almost nine out of 10 (87 per
cent) respondents thought that it is a health risk for a baby
if its mother smoked during pregnancy. Respondents were less certain
about the health consequences for a baby if its mother is exposed
to passive smoke during pregnancy. Almost three-quarters (74 per
cent) thought that there were risks but one in 10 said that they
did not know.
39. These results suggest that there are gaps in awareness
of the consequences of passive smoking for child health. A Gallup
Poll for the Doctor Patient Partnerhsip (DPP), working with the
National Asthma Campaign and the Foundation for the Study of Infant
Deaths, also found that many people are unaware of the possible
effects of passive smoke on child health.[11]In
their telephone survey of 2,039 adults, a quarter of respondents
said that they did not know which infancy and child health problems,
if any, are linked to parental smoking.
40. One in 10 respondents in the DPP survey refuted any
link between child health and parental smoking—replying
that none of the prompted health problems were linked to parental
smoking. Highest awareness, as in the Consumer's Association survey,
was of the link between parental smoking and childhood respiratory
problems—41 per cent of the total sample (rising to 50 per
cent in those with children aged under 16 in the house) recognised
the link between parental smoking and childhood asthma. Over a
fifth (22 per cent), recognised childhood chest infections as
being linked to parental smoking. Awareness of the links with
glue ear and cot death was particularly low—2 per cent and
7 per cent respectively acknowledged the link.
41. The Doctor Patient Partnership survey also found
that most people were aware that child health problems do not
only arise from breathing smoke directly at a baby or child. Over
three-quarters (77 per cent) disagreed or strongly disagreed with
the statement that "as long as people do not breath smoke
directly at a baby or child they will not suffer any health problems
from people smoking in the home". However, this still leaves
25 per cent who are not fully aware of the risks to children of
smoking in the home. Similarly, 18 per cent believe that smoking
in another room in the house does not harm a baby's or child's
health. It is encouraging, however, that awareness of the risks
is generally higher in those who have children under 16 in the
house.
42. The results in this section highlight some gaps in
the awareness of the health risks associated with smoking and
passive smoking. In particular:
— there is scope for improving awareness of the
consequences of smoking for heart health;
— there is also scope for increasing awareness of
some of the implications of parental or passive smoking for children
and babies; and
— it appears that smokers may be more accepting
of the health risks they face themselves, but are less aware or
accepting of the potential consequences of their smoke on others.
ATTITUDES TO
SMOKING AND
PASSIVE SMOKING
43. The survey explored public opinion about smoking
and passive smoking and the responsibilities of smokers. Respondents
were asked to state whether they agree strongly, agree slightly,
neither agree nor disagree, disagree slightly or disagree strongly
with some attitude statements.
Attitudes to a smoky environment
44. Over half (52 per cent) disagreed with the statement
"I don't mind being in a smoky environment", although
over a third (35 per cent) agreed with it. Smokers and non-smokers
are completely polarised on this issue. Over two-thirds (69 per
cent) of non-smokers disagreed with the statement compared to
only 17 per cent of smokers. Conversely, 68 per cent of smokers
agreed with the statement in contrast with 19 per cent of non-smokers.
The more people smoke the less they mind being in a smoky environment.
Nonetheless, almost 20 per cent of light and medium smokers disagreed,
and 21 per cent of light smokers were neutral.
45. Analysis by place of exposure to other people's smoke
suggests that people exposed to other people's smoke in the home
are least likely to mind a smoky environment—over half (54
per cent) agreed with the statement. Over a third (36 per cent)
of those exposed to passive smoke at work and almost half (48
per cent) of people exposed to smoke socially do mind being in
a smoky environment. These results point to substantial numbers
of people (eg half of the 60 per cent exposed to passive smoke
socially) regularly exposed to other people's smoke which they
find unpleasant.
46. The statement, "It's irresponsible to smoke
near babies and children", had very broad support. The majority
of people—more than eight in 10—agreed strongly that
it is irresponsible to smoke near babies and children and a further
12 per cent agreed slightly. Thus, in total, 93 per cent were
in agreement. Although there is some difference between smokers
and non-smokers, there is a high degree of support for this statement
from both groups—87 per cent of smokers and 95 per cent
of non-smokes agree with the statement.
47. Although a majority of people agreed that smokers
should not smoke around other people, their convictions were not
as strong as they were toward babies and children. Of the 63 per
cent who agreed with the statement, 35 per cent agreed strongly
and 28 per cent agreed slightly. In total, 19 per cent disagreed
with the statement and 17 per cent were neutral.
48. Attitudes to this statement are dramatically polarised
between smokers and non-smokers. Of non-smokers, 72 per cent agree
with the statement while only 43 per cent of smokers agree. Smokers
were more likely to disagree with the statement (32 per cent compared
to 13 per cent of non-smokers) or to neither agree nor disagree
(24 per cent compared to 14 per cent of non-smokers).
49. People exposed to passive smoke in places they visit
socially are more likely to agree with this statement that people
exposed to other people's smoke at work or in the home (58 per
cent, 52 per cent and 45 per cent respectively agreed with the
statement). Once again this highlights a sense of dissatisfaction
among people exposed to passive smoke in social situations, suggesting
that action in this area would be welcome.
50. This exploration of the attitudes of smokers and
non-smokers to smoking and passive smoking suggests that:
— there is broad support for the idea that smokers
have responsibilities, especially when it comes to babies and
children;
— although people do believe that smokers have responsibilities
to other adults, these beliefs are not so strong and views are
polarised between smokers and non-smokers; and
— there appears to be some disenchantment of people
exposed to other people's smoke, particularly in social situations
or in the workplace, suggesting that action to increase access
to smoke-free environments would receive support.
ATTITUDES TO
GOVERNMENT INTERVENTION
51. Attitudes to government action to control tobacco
were explored in the survey. Again, respondents were asked whether
they agreed or disagreed with some attitude statements. Attitudes
to tobacco companies and their responsibilities for smoking-related
diseases were also explored. In addition, results of two earlier
surveys are reported: (a) a 1998 TGI survey[12]on
attitudes to a possible ban on smoking in public places and (b)
a survey 1997 of Consumers' Association members[13]on
tobacc advertising controls.
Government action to discourage smoking
52. The majority of respondents (67 per cent) agreed
with the statement "the government should do more to discourage
smoking'. This endorsement of government action was quite emphatic—45
per cent of respondents agreed strongly compared with only 7 per
cent who disagreed strongly.
53. Although there were differences between smokers and
non-smokers, there was still considerable support for government
intervention among smokers. Three-quarters of non-smokers and
half of smokers agreed with the statement. Over a third of smokers
(34 per cent) disagreed with the statement in contrast to only
14 per cent of non-smokers. When analysed according to the amount
smoked, there was no general pattern.
54. People exposed to other people's smoke at work or
socially are more likely to support government intervention than
those exposed in their home. Of those exposed to passive smoke
at home, 56 per cent agreed with the statement compared to 69
per cent of those exposed at work, and 65 per cent of those who
passive smoke in social situations.
Legal age of smoking
55. Once again, the notion of government intervention
commanded support. Almost three-fifths (59 per cent) agreed with
the statement that the legal age of smoking should be raised to
18. O these, 42 per cent agreed strongly and 17 per cent agreed
slightly.
56. This measure attracted support from both smokers
and non-smokers. This was unusual among the attitude statements
in that there was little difference between the two groups. Among
the smokers, agreement with the statement declines as the amount
smoked increases—62 per cent of light smokers agree that
the legal age should be raised to 18 compared with 60 per cent
of medium smokers and 52 per cent of heavy smokers. There were
no differences between those exposed to other people's smoke in
the home, at work or in places that they visit socially.
Current restrictions on smoking
57. Potential support for government action was underlined
by the fact that less than a third (30 per cent) agreed with the
statement that "there are too many restrictions on smoking
these days". Thirty-seven per cent disagreed strongly with
the statement and a further 22 per cent disagreed slightly. Smokers
and non-smokers responded differently to this question. Over half
of smokers (55 per cent) agreed that there are already too many
restrictions compared to only 18 per cent of non-smokers. Almost
three-quarters of non-smokers (72 per cent) disagreed with the
statement in contrast to only a third of smokers. The more that
people smoked, the more they agreed with this statement and the
less that they disagreed.
58. People regularly exposed to other people's smoke
in social situations and those exposed at work are more likely
to disagree that current restrictions are too heavy than those
exposed to passive smoke at home (58, 50 and 43 per cent respectively
disagreed).
Attitudes to tobacco companies
59. Mistrust of tobacco companies is high. Over half
of respondents (56 per cent) agreed strongly or slightly with
the statement "I don't trust tobacco companies". Only
16 per cent disagreed with the statement and a relatively high
proportion (25 per cent) neither agreed nor disagreed. Although
non-smokers are more likely to mistrust the tobacco industry,
it is notable that 45 per cent of smokers mistrust tobacco companies.
Heavy smokers in particular are more likely to agree that they
don't trust tobacco companies (although this is the smallest group
in numbers so some care is needed in interpreting the data). More
than three-fifths of those who smoke 20 or more cigarettes a day
agreed that they do not trust tobacco companies. This compares
to 43 per cent of light smokers and 42 per cent of medium smokers.
60. Respondents were asked whether they agreed with the
statement that "tobacco companies should pay the NHS for
treating smoking-related diseases". In total, 60 per cent
agreed with the statement with two thirds of those in strong agreement.
A quarter of people disagreed with this proposition.
61. Non-smokers were more likely to agree that tobacco
companies should pay tobacco-related costs to the NHS than smokers.
Sixty-three per cent of non-smokers agreed with the statement
compared to 54 per cent of smokers. Their views are not as polarised
on this issue as they are on many of the other questions. Heavy
smokers are more likely to agree and disagree that tobacco companies
should pay the NHS for smoking-related diseases and they are less
likely to be neutral.
A ban on smoking in public places
62. In 1998, TGI asked 25,560 people whether they thought
that smoking should be banned in public places. In total, over
half of respondents agreed that smoking should be banned, 14 per
cent were neutral and 22 per cent disagreed. Unsurprisingly, these
views differed between smokers and non-smokers. At 68 per cent,
non-smokers were more than three times more likely to agree with
a ban than smokers (20 per cent agreed). Light smokers were more
likely to agree with a ban than heavy smokers and vice-versa.
Support for measures to control promotion of tobacco
63. In September 1997 a survey of Consumers' Association
members found considerable support for a ban on various forms
of cigarette promotion. Over three-quarters (78 per cent) thought
that direct mailing to promote cigarettes should definitely or
probably be banned. A ban on cigarette branded merchandise and
poster/magazine advertising was supported by 70 per cent. Sixty
per cent thought that sponsorship of sport events should definitely
or probably be banned (47 per cent definite and 13 per cent probable).
64. These results reveal:
— a high degree of support for government intervention;
— in particular, there is support for the protection
of young people from tobacco;
— in general, non-smokers are more supportive of
government action than smokers—except in relation to the
raising for age-restriction on smoking which commands broad support.
IMPLICATIONS FOR
POLICY AND
PRACTICE
65. The findings of this survey, backed up by other work,
have a number of implications for the development of tobacco control
policy and for the delivery of health promotion and messages about
the health risks associated with tobacco. This section summarises
the key findings and their possible policy implications.
More than three-quarters of the population are regularly exposed
to other people's smoke
66. There is clearly scope for improving this situation.
Further research highlights that people regularly exposed to other
people's smoke—particularly at work or in social situations—are
more likely to think that smokers should not smoke around other
people and are more likely to object to a smoky environment. This
suggests that there is considerable dissatisfaction with the inevitability
of exposure to other people's smoke. The research did not explore
specifically attitudes to an information scheme for choosing smoke-free
or less smoky environments, but it does suggest that measures
to improve access to smoke-free environments would receive broad
support.
Most people are well aware that smoking carries health risks,
but awareness of some smoking-related conditions was higher than
for others
67. In particular, awareness of the consequences of smoking
for heart disease, heart attacks or angina was relatively low.
The research suggests that cancer generically (prostate cancer,
for example, was thought by many to be caused by smoking) and
respiratory conditions are commonly associated with smoking. The
increased risk of cardiovascular disease, however, was not well
recognised. There is scope for health promotion agencies, heart
health charities and health professionals to focus on enhancing
the message about the links between smoking and heart disease.
Most people do recognise that there are health risks associated
with passive smoking, but many smokers still refute any connection
68. The research does highlight considerable numbers—although
they are in the minority—who still refute the link between
health problems and passive smoking and there appears to be some
resistance to the link between passive smoking and lung cancer.
Awareness of the risks of passive smoking could be improved; the
fact that 95 per cent of the population accept the link between
lung cancer and smoking indicates that it is possible to get a
very high awareness of health risks associated with tobacco. There
are considerable differences between smokers and non-smokers on
this issue—more so than in relation to the risks associated
with smoking. This suggests that smokers have more readily accepted
the risks to their own health than the problems their smoke may
cause for others.
There are gaps in the awareness of the links between parental
or passive smoking and the health of babies or children
69. Awareness of the risks to children's health caused
by smoking was very high in relation to asthma, chest infections
and bronchitis. Recognition of the links to glue ear and diabetes,
however, was very low. Results from a separate survey confirmed
these gaps in awareness about child health and passive smoking
and revealed some confusion about how these risks to babies and
children can be avoided. There is clearly scope for improving
communication of the health risks to babies and children, particularly
to smokers.
There is broad support for the idea that smokers have responsibilities,
particularly when it comes to babies and children
70. The majority of smokers and non-smokers alike agree
that it is irresponsible to smoke near babies and children. A
majority also believes that smokers should not smoke around other
people, but these beliefs are not so strongly held and a third
of smokers disagree.
There is a high level of support for government intervention
on tobacco, particularly in relation to protecting young people
and children
71. Most people—including half of the smokers surveyed—agree
that the government should do more to discourage smoking. Similarly,
support for raising the legal age of smoking to 18 is high among
smokers and non-smokers. The issue remains controversial, however,
since there is still resistance to increasing the restrictions
on smoking. Although a minority considered that current restrictions
on smoking are too heavy, this included half of the smokers..
Although an earlier survey found a majority in favour of a ban
on smoking in public places, more than two-thirds of smokers disagreed.
72. In general, the results suggest that the following
may command particular support:
— measures to protect children and young people;
— measures to increase access to smoke-free environments;
— controls on the advertising and promotion of tobacco
products.
73. The government has stated as one objective, the reduction
of smoking among children and young people. The results of this
survey do suggest that the government would receive broad support
were it to extend this to the protection of children and young
people from smoke. Measures to ensure smoke-free environments
for babies and children, raising the age limit for the purchase
of tobacco, support for parents (not just mothers) in giving up
and increased information on the health risks to children could
be popular approaches.
74. As outlined above, there are diverging views about
smoking and there will be no escaping the controversy around smoking
and tobacco control for the government. However, while some people
remain opposed, there is also considerable support amongst smokers
for government action.
6
Consumers' Association, The big stink, Health Which? December,
1998. Back
7
Consumers' Association, Smoking and passive smoking: public
perceptions of risk, Consumer Policy Review, Sep/Oct, 1999. Back
8
Smoking Kills, Department of Health, 1999. Back
9
Saving Lives, Our Healthier Nation, Department of Health,
1999. Back
10
BMRB, 1998. Back
11
Doctor Patient Partnership (1999) Passive Smoking in Children:
what the public still don't know. Press Release 23 March 1999. Back
12
Target Group Index@BMRB Int, 1998. Back
13
Consumers Association, Membership survey, 1997. Back
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