Int J High Risk Behav Addict. 2015 March; 4(1): e20939. DOI: 10.5812/ijhrba.20939
Published online 2015 March 20. Research Article
Personal Fable: Optimistic Bias in Cigarette Smokers
Marianna Masiero 1,2,*; Claudio Lucchiari 1,2; Gabriella Pravettoni 1,2
1Department of Health Sciences, University of Milan, Milan, Italy
2Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
*Corresponding author: Marianna Masiero, Department of Health Sciences, University of Milan, P. O. Box: 20123, Milan, Italy. Tel: +39-0250321228, Fax: +39-0250321240, E-mail: Mari-
Received: June 3, 2014; Revised: September 8, 2014; Accepted: September 15, 2014
Background: Several empirical studies have shown the attitude of smokers to formulate judgments based on distortion in the risk
perception. This alteration is produced by the activation of the optimistic bias characterized by a set of the unrealistic beliefs compared to
the outcomes of their behavior. This bias exposes individuals to adopt lifestyles potentially dangerous for their health, underestimate the
risks and overestimate the immediate positive eﬀects.
Objectives: This study aimed to analyze the relationship between optimistic bias and smoking habits. In particular, it was hypothesized
that smokers develop optimistic illusions, able to facilitate the adoption and the maintenance over time of the unhealthy lifestyles, such
as cigarette smoking, and the former smokers could acquire a belief system centered on own responsibility.
Patients and Methods: The samples (n = 633, female = 345, male = 288) composed of smokers (35.7%), ex-smokers (32.2%) and nonsmokers
(32.1%). Each participant ﬁlled out two questionnaires including The Fagerström test and the motivational questionnaire as well as a set of
items measured on a Likert scales to evaluate health beliefs.
Results: The results conﬁrmed the presence of the optimistic bias in comparative judgments, and the attitude to overestimate the
eﬀectiveness of their preventive behaviors in the smokers.
Conclusions: Cognitive bias in risk perception may inﬂuence health behaviors in negative way and reinforce cigarette smoking over the
time. Future research should be conducted to identify the better strategies to overtake this cognitive bias to improve the quitting rate.
Keywords:Decision Making; Nicotine Dependence; Bias; Risk
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For a long time, the study of the addictive behavior has
been based on a biological model, which highlighted
the role of brain chemistry and neurological consid-
erations. In this approach, nicotine dependence has
been explained as a consequence of limbic and cortical
structures malfunctioning, that was produced by a do-
paminergic up-regulation. Actually, nicotine alters the
reinforcement signal processing in ventral regions of
the basal ganglia thus determining a brain neuro-adap-
tation to the substance. However, starting by the 1990s a
new cognitive model introduced further perspective on
smoking. These models are essentially based on the study
of risk, since risk dis-perception was considered a major
factor in favoring initiation and maintaining an unsafe
behavior over the time (1, 2).
While previous psychological research had stressed the
role of the motivational factors and impulsiveness (3),
the new paradigm suggested that smokers’ mental mod-
els and their belief system might also be considered to
understand individual behaviors and decision making,
in particular when risks should be weighted on beneﬁts
to follow the best option (e.g. smoking versus nonsmok-
According to Slovic (5, 6) an individual may take dis-
advantageous decisions not only when aﬀective com-
ponents are purposely manipulated (e.g. in marketing
actions), but also when cognitive distortions and biased
beliefs are present. Actually, research on smokers’ behav-
iors has shown that they tend to underestimate both the
long-term and short-term risks of the tobacco consump-
tion. Consequently, smokers’ judgment tends to be driv-
en by anticipatory feelings elicited by previous experi-
ences and consolidated beliefs (7).
Generally speaking, we may state that risk perception
is the result of an intrasubjective cognitive assessment.
The information processing involves both cognitive and
emotional processes. For this reason the risk perception
cannot be considered a pure logic and objective evalua-
tion. In particular, three diﬀerent elements should be
taken into consideration to understand health-related
risk assessment including the perceived vulnerability,
the preventive eﬃcacy and unwarranted optimism. The
perceived vulnerability is the degree to which an individ-
ual feels to be personally exposed to health consequences
due to their own behavior. A high level of vulnerability in
smokers is generally associated with a:
Masiero M et al.
Int J High Risk Behav Addict. 2015;4(1):e209392
- high level of motivation to give up smoking (8);
- high probability to be involved in smoking cessation
- high likelihood to do a real attempt to give up (9)
It has also been observed that cancer patients with high
level of perceived vulnerability generally show a higher
motivation to quit (10), and a better success rate (11). The
preventive eﬃcacy is related to the belief of an individual
to be able to carry out preventive actions (e.g. physical
activity) to obtain health beneﬁts. Individuals with high
levels of preventive eﬃcacy believe that their decisions
(e.g. to stop smoking) will actually preserve their future
health. Smokers motivated to give up generally show
high level of preventive eﬃcacy and perceive higher ben-
eﬁts associated with smoking discontinuation; However,
the former smokers who report to perceive high level of
health beneﬁts often fail to sustain their abstinence over
time (9, 12).
Finally, the unwarranted optimism, also called optimis-
tic bias (13) is a cognitive bias that push people to believe
to be invulnerable to a potential risk’s source (14, 15), al-
lowing them to feel a sense of control over the eﬀects of
their choices. This bias leads people to underestimate
risks when considering themselves, while being more
realistic (or pessimistic) when considering other peo-
ple’s behaviors. The optimist bias entails a "ﬁrst-person
evaluation" as opposed to a “third-person evaluation”;
for instance, smokers are usually more optimistic about
themselves rather than others. Thus, when they use a
ﬁrst-person evaluation of smoking-related risks, they are
much more optimistic than when they evaluate others’
risks (e.g. “I can stop when I want” or “Since my grand-
father died 80 years old smoking 20 cigarettes a day, I’ve
got good genes”). This optimistic illusion seems to be the
result of two distinct mental processes (16-19):
-The illusion of control, due to the overestimation of
preventive behavior eﬃcacy (e.g. increased physical ac-
tivity that decreases the perceived need to stop). The il-
lusion of control leads smokers to the false belief that
they will able to stop when they want. In this way, they
categorize smoking as a controllable and removable be-
havior. Only later, after repeated failed quit attempts,
they come to understand to be nicotine-dependent. For
instance, among occasional smokers, namely who smoke
less than a cigarette a day, only 15% think that within 5
years could become a heavy smoker, thus developing a
chronic dependence to nicotine. Moreover, among heavy
smokers, 32% consider that within 5 years they will still be
a smoker, while 68% believe that will interrupt. In reality,
the oﬃcial statistics show that after 5 years 70% of people
keep on smoking (20).
- The need to preserve a good self-esteem level. Indeed,
one’s self-esteem is generally threatened when a risk is
not avoided. At the opposite, one’s self-esteem increases
when self-eﬃcacy is high (21, 22).
In this way, smokers develop illusory beliefs to justify
their behaviors and reduce the negative feelings associ-
ated to the adoption of a risk choice that could be avoid-
ed. Being able to ﬁnd arguments in favor of others’ risks
(e.g. a high genetic vulnerability), smokers succeed in
managing the cognitive dissonance due to the mismatch
between risk perception (“smoking may be hazardous”)
and the actual behavior (14). This optimistic thinking is
linked to the memory functioning, since a recurrent be-
havior is more easily accessible, and due to a habitation
eﬀect, they are considered acceptable though being risky.
This implies that, when a person assesses speciﬁc levels
of risk (e.g. the likelihood to develop a lung cancer due to
heavy smoking) available memories will guide judgment
instead of an objective assessment (23, 24). Finally, the
optimistic bias may be linked to so-called wishful think-
ing including cognitive distortions produced by desir-
able situation, events, subject and/or object evaluation.
This distortion leads people to consider the occurrence
of an event more likely than another only because it is
more desirable. For instance, smokers may conclude that
smoking is not riskier than other behaviors, just because
this is a wishful consideration.
It is important to note that both adolescent and adult
smokers are generally able to recognize the hazardous
smoking in a long-run perspective and the existence of
smoking-related diseases (e.g. lung cancer, cardiovas-
cular problem and other cancer syndrome) (4, 25).They
show to have an adequate information about these is-
sues; nevertheless, they show ambiguous attitudes to-
wards risk, since they don’t relate their choices to health
The present study aimed to analyze the inﬂuence of the
optimism bias and illusionary beliefs that support smok-
ing initiation, consolidation and maintenance over time.
Moreover, this study aimed to evaluate four main hypoth-
eses as follows:
1- Since smoking-related issues are common in the
whole society, in smokers and nonsmokers , we hypoth-
esized that smokers with respect to nonsmokers show an
optimistic bias, being more benevolent when evaluating
ﬁrst-person risks than third-person ones. At the opposite
nonsmokers and former smokers should be more realis-
tic, showing balanced judgments.
2- We hypothesized that former smokers develop a spe-
ciﬁc belief system to support their abstinence. In particu-
lar, we supposed former smokers having higher smok-
ing-related risk perception than smokers. At the same
time, we argued that former smokers feel to modulate
the eﬀects of previous smoking on their health by their
3- Finally, since risk perception and health-related be-
liefs are modulate by behavioral, psychological and de-
mographic variables, we hypothesized that age, gender,
smoking habits (nicotine dependence) and motivation
to quit should aﬀect the smokers’ cognitive distortions.
Masiero M et al.
Int J High Risk Behav Addict. 2015;4(1):e20939
3. Patients and Methods
The sample was recruited in collaboration with the
Interdisciplinary Research Center on Decision (IRIDe)
of the University of Milan. The research was conducted
from January 2013 until June 2013. The sample is made by
633 volunteer participants (Female = 54.5%; Male = 45.5%),
recruited through internet sites. During a telephone con-
tact, all the needed information was delivered and if the
subject agreed to participate in the study, an e-mail with
the study description, the informant consent and a link
to an online questionnaire was sent to him/her. The time
to complete the protocol was about 20 minutes for all
conditions. Subjects had the possibility to contact a re-
searcher by an e-mail or telephone on demand. After the
completion of the procedure, each subject was contacted
for a fast debrief. An opportunistic sampling method was
used. The mean age of the samples was 48.01 years (stan-
dard deviation = 15.203), with an age range of 19-74 years.
The samples were classiﬁed into three clusters: smokers
(35.7%), ex-smokers (32.2%), and nonsmokers (32.1%).
Two standardized questionnaires were used:
-The Fagerstrom test for nicotine dependence (FTND)
(26) to assess the dependence level both physiological
- A motivational questionnaire to evaluate the intention
to give up smoking (27);
To evaluate smoking-related beliefs, we used a set of
Likert scale questions. The Fagerström test for nicotine
dependence is a 6-item self-administered questionnaire.
The scale evaluates three main dimensions including the
average daily amount of cigarette smoked, the nicotine
compulsion, and the general level of dependence. The
total score ranges from a minimum of the 0 points to a
maximum of the 10 points, with the following meanings:
0-2 mild dependence, 3-4 not severe dependence, 5-6
strong dependence, 7-10 very strong dependence.
The motivation to give up smoking (27) consists of four
multiple-choice questions; to each is assigned a score
ranging from 1 to 4. The total score allow to classify smok-
ers into one of four motivational clusters: 4-6 low (not
yet seriously considered to give up smoking); 7-10 middle
(the person evaluated both the beneﬁts of quitting and
the risks of smoking); 11-14 high (there are moments in
which the person is determined to quit smoking); 15-19
very high (the person is ready to give up smoking).
To assess the system of subjects’ beliefs, we collected
a set of 11 assertions (Appendix 1) adapted by previous
works (12, 14). The translation and the cultural adaptation
of items were performed by a panel of expert, including
two psychologists, one counselor expert in tobacco ces-
sation and one professional English to Italian translator.
To study the face validity of items, we asked 20 subjects
(all smokers) to indicate whether the questions were
clear, understandable, and in a logical order. To further
validate our version of the instrument, we collected data
from 20 students of the University of Milan (20 smokers,
20 former smokers, and 20 nonsmokers) in a pilot phase
of the study. We performed a test-retest study, asking
participants to answer to the same items three months
after the ﬁrst trial, ﬁnding a mean test-retest correlation
(Spearman’s Rho) of 0.88 (range, 0.82-0.96).
Subjects were asked to rate themselves according to
each assertion on a 4-point Likert scale. Each item has
been built speciﬁcally to describe beliefs and opinions
with respect to smoking-related risks and dependence is-
sues. Consequently, items do not assess the individual’s
knowledge levels, since we wanted to assess biased cog-
nitive processes rather than notions. The ﬁrst 7 items
contain assertions on risk perception. These items are
semantically constructed to assess the self-oriented (ﬁrst-
person perspective) risk perception in contrast to a gen-
eral risk perception (third-person perspective). Items 8 to
11 consider smoking-related myths and cognitive strate-
gies used to cope with tobacco-related risks.
Data were processed using the (SPSS, IBM, USA) version
20.0. Descriptive statistics were used to analyze sample
characteristics. Most smokers (63%) had a moderate to
high nicotine-dependence level as measured by the Fag-
erström test. At the same time, the 41.7% of smokers re-
ported a high motivation score, and most fall between
high and middle level. Although our sample is quite
heterogeneous, most participants had a strong addic-
tion (mean of daily cigarettes = 20.181, standard deviation
= 12.246) and good motivation to quit. A series of cross
tables were created to ﬁnd associations between the an-
swers and smoking clusters (smokers, ex-smokers and
nonsmokers). The chi-square test was used to evaluate
Statistically signiﬁcant eﬀects were found in items 2, 3,
4, 8, and 11 showing diﬀerent distributions for the three
clusters. In particular, answering to item 2 many smokers
reported to doubt that the cigarette smoking could be a
possible cause of death, while former and nonsmokers
reported more realistic judgments (X2 = 25.469, df = 6, P =
0.000) with respect to well-known statistics. This result is
particularly important because when the subjective per-
spective (ﬁrst-person risk evaluation) is substituted by a
general perspective (risk for others), the optimistic bias
disappeared (Figure 1).
Also, answers to item 3 (X2 = 28.240, df = 6 P = 0.000)
and 4 (X2 = 23.436, df = 6, P = 0.001) showed diﬀerent dis-
tributions. These items refer to the smokers’ conﬁdence
in controlling their behavior. Consequently, we can say
that smokers tend to underestimate the power and the
salience of the nicotine addiction. In the third area, we
analyzed the preventive strategies enacted by respon-
dents to contrast the side-eﬀects of tobacco consump-
Masiero M et al.
Int J High Risk Behav Addict. 2015;4(1):e209394
tion. Diﬀerent distributions were observed in item 8 (X2
= 23.545, df = 6, P = 0.001) and item 11 (X2 = 13.724, df = 6,
P = 0.033). Smokers compared to nonsmokers trust more
on the power of the physical activity to contrasts the ciga-
rette smoking negative eﬀects. Furthermore, smokers
and ex-smokers seem to underestimate the association
between tobacco consumption and lung cancer (Figure
1). Smokers probably tend to develop this illusory belief
to contrast the mismatch between the pleasure for the
smoking (hedonistic dimension) and the health conse-
quences. Coherently with our second hypothesis, former
smokers probably need to believe that their previous be-
havior won’t have severe consequences on their future
health; otherwise, remaining abstinence could be per-
ceived as useless.
To address our third hypothesis, a similar analysis was
carried out on smokers considering motivational to give
up groups (low, middle, high) as measured by the moti-
vational questionnaire. However, no signiﬁcant diﬀer-
ence was found in judgments and beliefs among these
groups. The role of gender and age was also evaluated.
A statistical diﬀerence was found at the item 7: the male
ex-smokers reported more pessimistic evaluations on the
association between cigarette smoking and lung cancer
than female smokers (X2 = 13.553, df = 3, P = 0.004).
Four categories were considered to examine the eﬀect
of age: 19-40 years; 41-50 years; 51-60 years and 61-75 years.
Answers to the item 2, 4, 6 and 10 showed diﬀerent dis-
tributions for age categories. More in details, at the item
2 (X2 = 20.380, df = 9, P = 0.016) smokers under 40 and
smokers over 50 tend to underestimate the smoking-re-
lated risks. At the opposite, nonsmokers between 19 and
40 years showed higher awareness (X2 = 17.402 df = 9, P =
0.043) about smoking-related risks.
At item 4, younger smokers (aged between 19 and 40)
reported to underestimate the strength physical depen-
dence more than older smokers (X2 = 20.833, df = 9, P =
0.013). Indeed, they believed that cigarette smoking was
an easily controllable behavior. In the clusters of 51-60
and 61-75 years, an inversion of this trend was observed.
The younger ex-smokers (19-40 years) tended to under-
line their chances of contrasting disease development
due to protective behaviors (X2 = 30.771, df = 9, P = 0.000).
This trend was in accordance to answers to item 10, since
smokers over 60 underestimated the risk to develop the
lung cancer, if they had smoke just for few years (X2 =
29.352, df = 9, P = 0.001). Otherwise, smokers under 60 ad-
mitted this risk. It is interesting to note that the nicotine-
dependence level increased during time (X2 = 39.628, df
= 9, P = 0.000), since smokers in clusters 51-60 and 61-75
years reported higher level of dependence as measure
by the Fageström test. This datum suggests that smokers
with high levels of nicotine-dependence (and then the
number of cigarettes consumed) also reported a heavily
biased smoking-related risk perception.
In the 2011, the World Health Organization report on
the global tobacco epidemic as stressed that the cigarette
smoking is a ﬁrst cause of death in the world. Each year,
tobacco consumption kills six millions of people. Many
of these people develop a respiratory or cardiovascular
disease due to smoking; however, few of these individu-
als seem to be aware of this great problem. In 2010, it was
conducted a study in several American hospitals, and it
was discovered that the 47.6% of smokers admitted at the
emergency department for acute respiratory care did not
believe that the real cause was cigarettes smoking (28).
In smokers is strong the tendency to underestimate all
smoking-related risks. The need to defend the self-esteem
induces the addicted subject to develop a series of illusion
and false beliefs to support the choice to keep on smoking.
Item 2."I doubt that I would ever die from smoking even if
I smoked for 30 or 40 years."
Item 3. "Most people who smoke for a few years become
addicted and can't stop."
Item 8. "The physical exercise could cancel the eﬀects of
Item 11. "The overall risk of developing cancer depends more
on genes than other things."
Item 4. "I could smoke for a few years and then quit if I
Figure 1. Distribution of Answers at Items 2, 3, 4, 8 and 11
Masiero M et al.
Int J High Risk Behav Addict. 2015;4(1):e20939
The aim of this study was to investigate the belief system
in smokers and former smokers with respect to nonsmok-
ers. The theoretical framework we used is based on the con-
cept that the optimistic bias is structured on a set of mental
models (cognitive architecture) used to appraise health-re-
lated risk in diﬀerent contexts. Conﬁrming our hypotheses,
it emerged that the activation of a cognitive distortion is
produced by an error in evaluating smoking-related risk.
In particular, it was observed that smokers underestimate
the strength of their dependence and related problems. In-
deed, smokers generally consider having the control over
their smoking behavior. In this way, smokers do not iden-
tify themselves as being abusers; however, at the opposite
they believe that their behavior is the result of a hedonistic
(the pleasure of tobacco) and aware evaluation (5, 14).
Our data have also conﬁrmed a higher attitude of younger
smokers to neglect the risk to develop a strong dependence
due to nicotine absorption. Indeed, smokers between 19-40
years old consider the cigarette smoking as a consciously
driven behavior. Only later, after repeated failed quit at-
tempts, they come to understand their dependence to nic-
otine. Indeed, at the item 4 the answers of over 60 smokers
showed that the awareness of their dependence is greater
than in younger smokers. The obtained results from this
study are in agreement with those of the previous studies
(28-31), which have stressed both the experiential dimen-
sion of addiction and the limited capacity of people to ra-
tionally assess future consequences of their behavior (7)
understanding the real complexity of a psychological and
physical dependence to nicotine (5).
Another important result is the attitude of female smok-
ers to underestimate smoking-related risks compared to
males. This could explain the problem of the female smok-
ers to give up smoking and the great risk of a new female
smoking epidemic in some country, such as Italy (32). Previ-
ous research addressed this issue (33), ﬁnding associations
between the fear to increase the body weight (aesthetics
issues) and the perceived stress reported during the absti-
nence. This association might lead female smokers to un-
derestimate risks to sustain smoking also in the presence
of long-term negative consequences, preferring short-term
Actually, female smokers comparing with male smokers
reported to believe that cigarette smoking has a preven-
tive action against anxiety and depression and this belief is
a serious obstacle to smoking discontinuation. Moreover,
some researchers (34) have observed that females are more
inclined to strain the disadvantages provoked by the smok-
ing cessation, instead of the beneﬁts. This is a salient factor,
because the assessment of beneﬁts and the identiﬁcation
of potential risks are related both to the give-up motivation
and at the success rate of smoking cessation programs. In-
deed, smokers with high level of motivation to give up are
generally able to interrupt and to maintain the abstinence
over a long time period (35).
Finally, the tendency to overestimate the eﬃcacy of pre-
ventive strategies to contrast the negative eﬀects of ciga-
rettes (e.g. to carry out regular physical exercise, to adopt
a healthy diet, to increase vitamins intakes and so on) was
conﬁrmed. Smokers tend to adopt a series of preventive
behaviors with the belief to decrease risks for their health.
Regarding this issue, it is interesting to compare the beliefs
system of smokers and former smokers. We hypothesized
that also former smokers need such beliefs in order to sus-
tain their abstinence.
A high level of awareness about smoking-related risks
might be considered the ﬁrst motivational factor to con-
trast the pleasure associated with the cigarette consump-
tion. Actually, they reported strong convictions about the
hazardous eﬀects of smoking. Furthermore, ex-smokers
seem to have developed a considerable trust in the power
of a healthy lifestyle to contrast all the risks associated with
the previous smoking behaviors. In this way, former smok-
ers may sustain their abstinence by believing that now they
elude smoking-related risks thanks to healthier choices.
Otherwise, thinking that the tobacco consumption had
already impacted their health irremediably could weaken
the decision to remain abstinence.
In conclusion, smokers and former smokers showed a
diﬀerent beliefs system. In particular, ex-smokers tend to
assume the responsibility of their health, overestimate the
impact of their decision, while smokers are more optimis-
tic on their future and on their capacity to monitor health
consequences. This optimistic perspective seems to put on
the subject a "veil of Maya”, which changes how the reality
is seen, leading to harmful behaviors by overshadowing
rational judgments. The unrealistic optimism is an impor-
tant obstacle to interrupt the smokers' attempts, because
it prevents the transition to the full awareness of tobacco
consumption. This lack of awareness hinders the passage
through the spiral of change (36) by developing the neces-
sary motivation to quit.
Unfortunately, contrasting this optimistic distortion is
not an easy task (1): however, developing of a strong indi-
vidual awareness is fundamental to improve the likelihood
of the adaptation of a healthy behavior. We argue that the
comprehension of the cognitive processes of smokers is an
important starting point, since it allows the understand-
ing of the complex nature of smoking to promote tobacco
cessation interventions able to ﬁt with smoker needs. Since
many antismoking interventions are only based on drugs,
behavioral change and nicotine substitution strategies
without considering the cognitive issues, investigate how
smokers thinks about their behaviors and their risks is par-
ticular important. In particular, the use of the electronic
cigarettes that promises to be the next frontier to contrast
tobacco consumption in the near future should be ana-
lyzed within this framework to avoid the substitution of
bad behavior with another one.
In conclusion, our data showed interesting suggestions to
better understand the smoker’s mind. However, this study
has several limitations, in particular, the quantity and the
quality of the sample and the data collection methodology,
which do not allow drawing easy generalizations, since
Masiero M et al.
Int J High Risk Behav Addict. 2015;4(1):e209396
this is a survey study that do not permit variable manipula-
tions. For this reason, we have limited the complexity of the
data analysis to allow a simple and direct reading. However,
we argue that our data suggest future lines of research able
to verify the size eﬀect and generalizability of our results
other than to promote cognitive-based intervention to im-
prove the adoption of healthy lifestyle and increase the ef-
ﬁcacy of antismoking cessation programs.
Dr. Marianna Masiero, Prof. Claudio Lucchiari and Prof.
Gabriella Pravettoni designed the study and wrote the pro-
tocol. Dr. Marianna Masiero managed the literature search-
es and summaries of previous related works. Prof. Claudio
Lucchiari undertook the statistical analysis, and Dr. Mari-
anna Masiero wrote the ﬁrst draft of the manuscript. All
authors contributed to and have approved the ﬁnal manu-
Items Used to Evaluate Health Beliefs
Most People Who Smoke all Their Lives Eventually Die From an Illness
Caused by Smoking
I doubt that I would ever die from smoking even if I smoked for 30 or 40
Most people who smoke for a few years become addicted and can’t stop.
I could smoke for a few years and then quit if I wanted to
How likely do you think that cigarette smokers will develop lung cancer?
How many people who have developed lung cancer do you think are cured?
Would you say smokers compared to non-smokers have:
The same lung cancer risk
A slightly higher lung cancer risk than
A double lung risk
Ten or more times
The non-smokers lung cancer risk
Physical exercise could undo most of the eﬀects of smoking.
Vitamins could undo most the eﬀects of smoking.
There is no risk of getting cancer if you only smoke a few years.
The overall risk of getting cancer depends more on genes than anything
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