Smokers' accounts on the health risks of smoking: why is smoking not dangerous for me?

Abstract

Drawing on qualitative interviews with forty smokers, aged 24-58 years, in Finland, this study aimed to identify key accounts that smokers used to respond to the hegemonic claim that smoking is harmful to health. While the smokers defended themselves in the face of the presumed health risk argument, they both agreed with and challenged the predominant medical and epidemiological discourses. The five most frequently observed account types that the smokers used were: health risk perspective, moderate use is not harmful, counter-evidence, compensatory behaviour, and smoking as the lesser evil. The accounts seemed to have two purposes. First, they served to protect the smokers from self-blame as well as blame from others. The smokers presented themselves as risk-aware and calculating actors, who have nevertheless made their choice to smoke. Second, the smokers tried to convince the interviewers and themselves of the harmlessness and acceptability of their own smoking. The results of the study with respect to smoking further the understanding about the way laypeople make sense of information about health risks that relates directly to their own 'unhealthy' behaviours and how they use this knowledge to justify their behaviour. Based on the findings of our study, we recommend that future anti-smoking campaigns and interventions should take into account and target lay epidemiological health accounts that are applied by smokers themselves. Rather than trying to motivate and persuade smokers to quit with information translated from epidemiological and medical research, the anti-smoking advocates and health promotion specialists should provide answers to the questions that smokers themselves are pondering and answering, too. Consequently, the results can be used in relation to other pleasurable but 'unhealthy' activities, such as unhealthy eating or drinking, by offering insights into how individuals manage to rationalise and maintain activities which the hegemonic public health perspective terms unhealthy.