Tobacco (56) Q1. Do people understand the harms of using tobacco products? (20) Ten comments from HIFA members: some surprising, a few shocking, all educational

13 March, 2023

Dear HIFA colleagues,

Thank you for your contributions so far. I have selected ten extracts relating to Question 1: Do people understand the health harms of using tobacco products?

1. Eduardo Blanco: Tobacco products are the world’s single largest cause of preventable death and disease, causing more than 8 million deaths each year.

2. Moderator: Do people understand the health risks? What about young people? Most people worldwide start using tobacco before the age of 18. In the USA and Europe people typically start at the age of 15 or 16. I myself started smoking at the age of 15 (I quit many years later). I was aware that 'smoking causes lung cancer' but I had no clue about its impact on other areas of health. As a teenager, this health risk that would probably not emerge for decades was of little consequence to me. Teenagers tend not to worry about what might happen 20 years in the future. As part of this discussion, I invite you to consider the drivers and barriers to communicating the health risks of tobacco to young people.

3. Chris Bostic, USA: In my work I've found that while everyone is aware smoking is dangerous, there are fundamental misconceptions about that danger. Most seem to think that, if you smoke, you simply drop dead when you are 70 rather than 80. They don't understand that for every death there are many people suffering for years with tobacco-related illnesses, or that the years lost come from the middle of life, not the end (i.e., people who smoke will decline with age more rapidly than non-smokers, on average).

4. Eduardo Bianco, Uruguay: Today, more smokers are aware of the damage caused by tobacco than a few decades ago, but most of them have a poor idea of its magnitude. They know that smoking causes lung cancer, but not that at least 8 out of 10 of these cancers are due to tobacco. Nor are they very clear about the relationship between tobacco and heart disease, and even less that the maximum increase in cardiovascular damage is observed with very few daily cigarettes. Even less is the knowledge between smoking and Stroke, and smoking and diabetes. But many times, not only smokers are not properly informed, but also health professionals.

5. Sian Williams, UK: In our experience in terms of primary respiratory care, in many countries there is a strong awareness about tobacco smoking and lung cancer but less awareness about tobacco smoking and asthma (the most common chronic disease in childhood) or tobacco smoking and chronic obstructive lung disease (COPD), the third leading cause of death worldwide. Data suggest people with asthma are more not less likely to smoke tobacco than those without asthma, which suggests scope for more research about why.

6. William Cotrone, USA: People who smoke but are aware of its health risks exhibit cognitive dissonance, a mindset in which attitudes and behaviors about a topic are not in sync. Tobacco use is a learned and socially mediated behavior. Experimenting with tobacco is therefore appealing to children because of connections they learn to make between tobacco use and the kind of social identity they wish to establish. Peer pressure constitutes a significant influence on the usage of tobacco as well (Lynch and Richard, 1994).

7. Eduardo Bianco, Uruguay: We are sharing a study carried out in Poland, but which reflects the reality of many other countries: On this study, the majority of the participants were aware of the fact that smoking cause severe diseases and lung cancer (92%). However, those percentages were lower for awareness of Environmental Tobacco Smoke and health risk (69.4%) and for awareness of smoking/ETS-associated risk of stroke and heart attack (57%, 68%).

8. Didier Demassosso, Cameroon: With respect to smoking and young people. There is something which has become more prominent in [Cameroon]. The "open smoking" of young boys and women. When I was in secondary school my peers would smoke only in our youth events (parties, birth days etc) and will make sure adults are not aware. Today, things are different. it is not uncommon to see adolescent boys smoking as they walk in the streets. Youths and women smoke more and more and in public places. I do not know if they had or have any idea of the health impacts of smoking. I myself, It is only when I engaged into health and biological studies that I clearly understood how detrimental smoking was.

9. Jum’atil Fajar, Indonesia: Based on data from the 2021 Global Adult Tobacco Survey [Indonesia], as many as 85.7% of adults believe that smoking causes serious illness. [implying that 15% do not believe that smoking causes serious illness]

10. Moderator: Below is a paper in the journal Tobacco Induce Diseases. Citation and abstract below. The full text reveals that one in ten people [in the United States] do NOT agree that smoking causes lung cancer. It seems that it is wrong for us to assume that knowledge of the link between smoking and lung cancer is near-universal. What do we know about the substantial minority who do not believe there is a link? What information (or misinformation) shapes their opinion?

Some of the above are surprising, even shocking to me. All are educational. I invite you to send further comments on these issues. You can contribute to the discussion by sending an email to:

With thanks,


Joint coordinator, HIFA project on Mental health: meeting information needs for substance use disorders - Tobacco, Alcohol, Opiates

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: