Health, Risk & Society,

September 2007; 9(3): 259 273

The moral career of cigarette smokers: A French survey

PATRICK PERETTI-WATEL1,2,3, SANDRINE HALFEN4, &

ISABELLE GREMY4
1

Health and Medical Research National Institute (INSERM), Research Unit 379, Social Sciences
Applied to Medical Innovation, Institut Paoli Calmettes, Marseilles, France, 2Southeastern Health
Regional Observatory (ORS PACA), Marseilles, France, 3French National Cancer Institute (INCA),
Paris, France, and 4Health Monitoring Centre of Paris Ile-de-France Region (ORSIF), Paris, France

Abstract
This paper aims to illustrate the relevance of Howard S. Beckers sociological model of deviance for a
better understanding of contemporary adult smoking. From this perspective, one crucial aspect of
smoking is smokers ability to develop and entertain convincing rationalizations that help them to deny
smoking hazards and challenge anti-tobacco messages. Several hypotheses are derived from this model
and most of them are successfully tested with quantitative data from a cross-sectional survey conducted
in the Paris Ile-de-France Region. As expected, most smokers agreed that smoking damages health and
considered being well-informed about smoking hazards, even those who denied these hazards for
themselves. Moreover, smokers rationalizations were closely correlated to cigarette consumption and
duration since smoking initiation. Paradoxically, risk denial was also stronger among smokers who
have some characteristics usually considered as protective factors against smoking (especially futureorientation and importance attached to ones health). More generally, our sociological perspective
leads to consider smokers risk denial as the result of acquired cognitive skills instead of the
consequences of lack of information or psychological bias. We believe it provides a promising avenue
for further research.

Keywords: Cigarette smoking, risk denial, moral career, France

Introduction
Do smokers underestimate risks?
According to the World Health Organization (WHO), tobacco is the second major cause of
death in the world, with about 5 million deaths each year. Most developed countries have
joined the global war on smoking. Nevertheless, despite extensive anti-tobacco policies,
smoking prevalence is still high in these countries. For example, in most European countries
between a quarter and a third of adults are still smoking (WHO 2003). Socio-behavioural
scientists frequently explain the persistence of such high smoking prevalence rates as a result
of enduring underestimation of health-related consequences of smoking. However, studies
conducted to assess smokers perceptions of risk have produced confusing or inconsistent
results (Sutton 1999, Weinstein et al. 2005). Such studies usually ask smokers to

Correspondence: Patrick Peretti-Watel, ORS PACA Inserm U379, 23 rue Stanislas Torrents, 13006 Marseille, France. Tel: 33 4 96
10 28 61. Fax: 33 4 96 10 28 99. E-mail: peretti@marseille.inserm.fr
ISSN 1369-8575 print/ISSN 1469-8331 online 2007 Taylor & Francis
DOI: 10.1080/13698570701486070

260

P. Peretti-Watel et al.

numerically estimate their own risk of experiencing tobacco related illness, or to compare it
with that of someone else, either a non-smoker or an average smoker.
Studies using the numerical approach frequently found substantial over-estimation of
risks (Marsh and Matheson 1983, Viscusi 1990, Boney McCoy et al. 1992), but the results
could be very different depending on whether the risk was assessed using proportions or
percentages (Borland 1997), and whether respondents have to assess one risk (getting a lung
cancer) or concurrent risks (lung cancer, car accident, suicide, homicide, etc.) (Slovic
2000). Moreover, smokers also overestimate their life expectancy (Schoenbaum 1997).
Despite some inconsistencies related to data collection methods, studies using the
comparative approach are more reliable in showing that smokers are prone to believe that
they have a lower risk of developing a smoking-related disease than the average smoker
(Hansen and Malotte 1986, McKenna 1993, Weinstein et al. 2005). This finding is usually
interpreted as an optimism bias: people generally believe that their personal risk is less than
the risk faced by others in the same situation (Weinstein 1989).
Thus it is often claimed that smoking cannot be interpreted as a choice made in the
presence of adequate information about the potential harm, as smokers awareness and
understanding about such harm is quite superficial and not systematically related to a
perceived personal risk (Fox 2005, Kozlowski and Edwards 2005, Weinstein et al. 2005).
According to Chapman and Liberman (2005), there are four levels of information (having
heard that smoking increases health risks; being aware that specific diseases are caused by
smoking; accurately appreciating the meaning, severity, and probabilities of developing
smoking-related diseases; personally accepting that the risks inherent in other levels apply to
ones own risk of contracting such diseases), and a smoker must have reached the fourth
level to be considered fully informed. From this point of view, the optimism bias
demonstrates a lack of information and most smokers, if not all, are not fully informed.
From misperception to risk denial: The moral career of smokers
Beyond the (mis)perception of risk issue, some studies also highlighted the propensity of
smokers to endorse smoking myths and self-exempting beliefs, for example exercise
undoes most smoking effects, cancer mostly strikes people with negative attitudes, lots of
doctors and nurses smoke, so it cannot be all that harmful, etc. (Chapman et al. 1993,
Oakes et al. 2004, Weinstein et al. 2005). Some of these studies endorsed a social psychology
perspective based on the theory of cognitive dissonance coined by Festinger (1957). This
theory is based on two assumptions: people need consistency between their behaviours and
their beliefs because inconsistency is disturbing and emotionally costly, and this consistency
is attainable by adjusting beliefs rather than changing behaviours. Within this theoretical
framework, observable beliefs are the result of a rationalization process intended to reduce
the dissonance. For example, smokers may entertain specific beliefs to dissipate the
cognitive dissonance created by widespread information about health-consequences of
smoking. From this perspective, smokers do not simply lack information about smoking
hazards, they rather actively entertain alternative beliefs to convince themselves that their
habit is not so risky.
The present paper proposes a similar perspective within a sociological model of deviance
initially developed by Howard Becker. According to Becker (1963), people who engage in a
behaviour labelled as deviant by the mainstream society have to neutralize this label with
convincing rationalizations, and these rationalizations will evolve all along the deviants
career (e.g., for a cannabis user: from initiation to regular use). Such neutralization process
shapes the deviants moral career and they should be considered as a crucial dimension for

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261

the analysis of any kind of deviance (Sykes and Matza 1957, Becker 1970). These
justifications are based on individuals own experience and that of their peers. They are not
deceitful a posteriori rationalizations.
Recently, Beckers model has been applied to cigarette smoking. Hughes (2002) showed
convincingly that cigarette smokers must learn to neutralize prevailing stereotypes and
understandings of tobacco use that depict smoking and smokers in a depreciative way. Using
the sociology of deviance to study smoking seems especially relevant in contemporary
societies. Indeed, since nowadays unhealthy behaviours tend to be labelled as deviant
behaviours, people with unhealthy habits are expected to deny the risky label just as
delinquents try to neutralize the deviant one (Peretti-Watel 2003a). As an updated variant
of Sykes and Matza neutralization theory, risk denial theory has been already used to study
the moral career of cannabis users and drug injectors (Peretti-Watel 2003b, Miller 2005).
Tested hypotheses
The present paper aims to illustrate the relevance of Beckers model of deviance for
contemporary adult smoking from a quantitative perspective making use of a cross-sectional
survey conducted in the Paris Ile-de-France Region. The following hypotheses were tested:
. According to Sykes and Matza, most delinquents do not escape from the pressure to
conformity to the dominant social order; they are still committed to conventional
norms, even if they sometimes neutralize such norms. Similarly, we assumed that
smokers neither ignore nor reject the public discourse about smoking harmful effects,
even if they endorse self-exempting beliefs (Hypothesis 1).
. In Beckers perspective, behaviours and beliefs are built together: beliefs sway
behaviours and reciprocally behaviours affect beliefs. Furthermore, beliefs vary across
the deviant career. For example, occasional and regular cannabis users do not share the
same beliefs on cannabis. Similarly, smoking-related beliefs are expected to vary with
the level of cigarette consumption (Hypothesis 2).
. Like Sykes and Matzas techniques of neutralization, risk denial beliefs can be
considered as learnt cognitive skills. Their acquisition probably depends on various
factors. For example, among French adolescents, the propensity to consider that
cannabis is a harmless soft drug is positively correlated to personal experience of use
(measured by duration since initiation) and cognitive sophistication (measured by
educational attainment) (Peretti-Watel 2006). We expected similar results among adult
cigarette smokers (Hypothesis 3).
. The last hypothesis is related to incentives that may fuel risk denial. Today, healthiness
is the new yardstick of accomplishment and moral worthiness, and health promotion
promotes a rhetoric of self-empowerment exhorting people to be future-oriented
(Giddens 1991, Lupton 1995, Rockhill 2001). Among smokers, those who are most
committed to healthiness and future orientation should feel more urged to justify their
habit (Hypothesis 4).

Methods
Sampling and data collection
With 11 million inhabitants over 12,000 km2, the Paris Ile-de-France Region concentrates
almost 20% of the total French population in only 2% of the countrys total area. But this

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P. Peretti-Watel et al.

region is also characterized by a high smoking prevalence (30%), with an average daily
consumption of 15 cigarettes among smokers (Oddoux et al. 2002). In 2000, the Health
Monitoring Centre of Paris Ile-de-France Region (ORSIF) carried out a random regional
telephone survey among people aged 18 75, with the Computer Assisted Telephone
Interview system (CATI), on Knowledge, Attitudes, Beliefs and Practices toward smoking.
In each contacted household, the next birthday method was used to choose which
member of the household should be asked to participate to the survey. The sample was
weighted by the inverse of household size (since the probability to be asked to participate was
proportional to this number). For basic socio-demographics, distributions in the sample
were also adjusted to distributions available from the 1999 Occupation Survey conducted by
the National Institute for Statistics and Economic Studies.
Questionnaire
Twenty-six in-depth interviews were conducted with smokers and non-smokers and analysed
before building the questionnaire, which was tested in a pilot survey among 50 people. The
final version included about 300 closed-ended questions, but the present study only exploited
a subset of them. Participants were asked to rate their level of agreement with a number of
smoking-related statements (using a 4-point Likert scale, from strongly agree to strongly
disagree). Eight of them assessed smokers propensity to risk denial: I have not smoked long
enough to be exposed to smoking-related diseases (cardiovascular diseases, lung cancer);
I dont smoke enough cigarettes to be exposed to smoking-related diseases; my family
antecedents protect me against health consequences of smoking; physical exercise protects
me against smoking-related diseases; living in a fresh air climate protects me against smokingrelated diseases; the way I smoke protects me against smoking-related diseases (given
examples: not inhaling all the smoke, not smoking the whole cigarette, smoking light cigarettes, smoking rolled cigarettes, buying cigarettes in small quantities); I have already smoked
too much so quitting now would not decrease my personal risk for having a smoking-related
disease; science and medicine will soon find a treatment to cure smoking-related diseases.
Several questions dealt with respondents smoking behaviour: smoking status (occasional
or daily smoker), number of cigarettes smoked per day (or per week for occasional smokers),
timing of the first cigarette smoked in the day (which is a good indicator of nicotine
dependence; Heatherton et al. 1991), number of years since smoking initiation and duration
of daily smoking. The questionnaire also investigated several topics which could be
interpreted as potential incentives for denying the risk induced by cigarette smoking:
importance attached to ones health, worrying about the future, and conflicts in the
household due to smoking. Lastly, background characteristics were recorded: gender, age,
occupation and educational level.
Statistical analysis
We performed a cluster analysis on the eight questions related to risk denial toward healthrelated consequences of smoking. This statistical tool was useful to emphasize which
opinions were endorsed by the same respondents, and to summarize the variety of their
answers in a limited set of contrasted profiles. It was thus convenient to detect meaningful
patterns of risk denial among smokers. Corresponding items were encoded from 1 (strongly
disagree) to 4 (strongly agree) to obtain scores. The resulting variables were transformed
to Z-score form prior to clustering. The cluster analysis was based on the usual
agglomerative hierarchical procedure (Everitt 1993): each observation begins in a cluster

The moral career of smokers

263

by itself, then the two closest clusters are merged to form a new one that replaces the two
former clusters, and the merging of the two closest clusters is repeated until only one cluster
is left. We used the Euclidean distance and the Wards method to compute the distance
between two clusters. At every step, clusters were less homogeneous but partitions become
more easily interpretable. Usually, analysts select a partition if it contains a reasonable
number of clusters that are easily interpretable. We compared partitions with four, five or six
clusters, and we opted for the four-cluster solution. From a statistical point of view, this
choice seemed relevant, as the next step of the hierarchical clustering (from four to three
clusters) induced a great loss of homogeneity.
We used F-ratio to compare means of each score across clusters (for the eight active
variables as well as for illustrative ones), and w2 to compare clusters according to
respondents background. We also used a logistic model to investigate factors associated
with these risk denial patterns. As the dependent variable was non-ordinal, we used a
multinomial logistic model that consists of taking one modality as the reference, and then
compares separately each other to this reference (McCullagh and Nelder 1989). Models
were built by selecting the more significant factors with the stepwise method (entry threshold
p 0.05). In these models, we considered duration since smoking initiation and number of
cigarettes smoked per week, in order to mix daily and occasional smokers.

Results
Data collected
Overall, 3,088 people were selected and asked to participate: 476 (15%) refused and 79
(3%) gave up during the interview. Interviews lasted about 40 minutes on average. Among
the 2,533 participants, 939 reported that they were currently smoking, at least occasionally
(80% were daily smokers, 20% were occasional smokers).
Opinions toward smoking
Overall, the last column of Table I shows that almost all smokers (97%) agreed that smoking is hazardous to ones health and considered being well-informed on this topic (91%).
Nevertheless, risk denial was also widely spread among them: about half of them believed that
physical exercise or living in a fresh air climate may protect them against smoking-related
diseases; one third considered they have not smoked long enough, or dont smoke enough
cigarettes, to be exposed to such diseases; another third believed that these diseases will soon be
cured definitely; and about a quarter considered to be protected by family antecedents or the
way they smoke. Finally, a quarter of smokers endorsed a fatalistic attitude (considering
that quitting wouldnt be beneficial for them because they have already smoked too much).
With regard to other opinions toward smoking, 53% of smokers thought they were slaves to
the cigarette, but at the same time 60% considered they were completely in control of their
cigarette consumption. Half of them didnt want to lose the pleasure of smoking and were
afraid to get even more stressed if they quit, while 37% were afraid that they would gain weight if
they quit.
Patterns of risk denial among smokers
The largest group, Cluster 1, gathered 38% of smokers (Table I) who strongly rejected risk
denial. Indeed, they obtained the smallest scores for almost all active variables, and all

Illustrative variables
I am a slave to the cigarette
I completely control my cigarette consumption
If I quit I am afraid I will gain weight
If I quit I am afraid I will get even more stressed
I dont want to lose the pleasure of smoking
Cigarette smoking is hazardous to ones health
I feel well-informed about health-consequences of cigarette
smoking
Smoking status:
Daily smoker
Occasional smoker
Smoking the first cigarette (for daily smokers only):
Within the first 5 minutes after waking-up
5 30 minutes after waking up
30 60 minutes after waking up
460 minutes after waking up

Active variables
I have not smoked long enough to be exposed to smoking-related
diseases2
I dont smoke enough cigarettes to be exposed to smoking-related
diseases2
My family antecedents protect me against health consequences of
smoking
Physical exercise protects me against smoking-related diseases2
Living in a fresh air climate protects me against smoking-related
diseases2
The way I smoke protects me against smoking-related diseases3
I have already smoked too much so quitting now would not
decrease my personal risk for having a smoking-related disease2
Science and medicine will soon find a treatment to cure smokingrelated diseases2

93%
7%
12%
19%
23%
46%

10%
24%
23%
43%

3.44

1.21

85%
15%

1.35
2.30

1.36
1.70

2.70
2.61
2.33
2.56
3.41
3.77
3.58

2.77
2.84

2.00
2.39

1.85
2.00

2.78
2.37
2.12
2.67
2.55
3.81
3.64

1.57

1.15

1.28

6%
16%
13%
65%

67%
33%

11%
21%
31%
36%

77%
23%

2.41
3.11
2.21
2.40
2.35
3.71
3.58

2.56

1.58

2.05
3.10
1.90
2.20
2.66
3.61
3.60

2.63
2.68

3.00
3.29

3.49

2.48

2.56

Cluster 4
(n 153)

2.12
1.82

2.90

1.47

1.53

2.83

Cluster 3
(n 266)

1.44

Cluster 2
(n 167)

1.38

Cluster 1
(n 353)

Table I. Mean scores from a cluster analysis on risk denial among cigarette smokers (ORSIF survey, n 939, 2000)1

10%
21%
22%
47%

1.93

50.001

50.001

1.78
2.00

50.001
50.001

80%
20%

2.32
2.52

50.001
50.001

50.001

1.70

50.001

2.50
2.74
2.11
2.47
2.53
3.73
3.61

2.06

50.001

50.001
50.001
0.002
50.001
0.031
50.001
0.796

1.99

All

50.001

p4

(continued)

53%
60%
37%
52%
53%
97%
91%

31%

23%
27%

52%
56%

23%

33%

31%

% agreeing

264
P. Peretti-Watel et al.

15.5
7.2
17.3
16.2

Cluster 1
(n 353)

15.5
6.6
20.0
18.5

Cluster 2
(n 167)

12.0
7.7
19.2
18.0

Cluster 3
(n 266)

14.6
8.3
22.6
20.9

Cluster 4
(n 153)

0.001
0.046
0.001
50.001

p4

14.6
7.6
19.2
17.8

All

_
_

% agreeing

Ordinal questions measuring opinions have been encoded from 1 (strongly disagree) to 4 (strongly agree). For these questions the columns give means for row variables.
The last column gives the percentage of respondents who answered strongly agree or agree. For each active variable the higher mean is in bold type, the lower mean is in
italics.
2
cardiovascular diseases, lung cancer, etc.
3
Main examples given by smokers: not swallowing all the smoke, smoking light cigarettes, not smoking the whole cigarette.
4
p-value for the F-ratio test testing differences in means for each row variable across clusters (and for the Pearsons w2 for smoking status and timing of the first cigarette
smoked in the day).

Cigarette consumption:
Number of cigarettes per day for daily smokers.
. . . per week for occasional smokers.
Number of years since smoking initiation
Duration of daily smoking (in years) (for daily smokers only).

Table I. (Continued)

The moral career of smokers

265

266

P. Peretti-Watel et al.

means were largely inferior to 3 (value corresponding to the agree statement). Smokers
endorsing this no risk denial attitude were also more prone to consider they were slaves to the
cigarette and to be afraid that quitting may increase their stress, and were less likely to
consider they controlled their cigarette consumption. With regards to their smoking
behaviour, they were more frequently daily smokers (85%), with the higher level of
consumption (15.5 cigarettes per day on average for daily smokers), and one third reported
smoking their first cigarette within the 30 minutes after waking-up. They were also smoking
for fewer years. This no risk denial pattern corresponded to heavier and younger smokers.
Respondents in Cluster 2 (18% of smokers) were quite similar to those of Cluster 1,
except that they were much more prone to think that medicine will soon find a treatment to
definitely cure smoking-related diseases, and to endorse a fatalistic perspective (considering
that they have too much smoked to benefit from quitting). With regards to other smokers,
they frequently considered themselves slaves to the cigarette, and they were more prone to
underline the potential adverse effects of quitting (gaining weight, stress, losing the pleasure
of smoking). Most smokers endorsing this fatalism and faith in medicine attitude were daily
smokers (93%), with a high daily consumption but average values for smoking duration.
Cluster 3 consisted of 28% of participants. With regards to the average smoker, they were
more likely to endorse several statements corresponding to protective behaviours (physical
exercise, living in a fresh air climate, way of smoking), and they were especially prone to
consider that they have not smoked long enough or enough cigarettes to be exposed to
smoking-related diseases. Such smokers were prone to consider they exert some control over
both their cigarette consumption and its health-related consequences. They were also less
likely to view themselves as slaves to the cigarette, and more likely to believe they completely
control their consumption. This self-control pattern of risk denial corresponded to lighter
smokers: one third were occasional smokers, they started smoking later in the morning, and
reported a lower average consumption.
Finally, Cluster 4 gathered 16% of respondents, who were characterized by high levels of
agreement for all risk denial statements (and especially those related to protective factors
such as family antecedents, physical exercise and living in a fresh air climate). With regards
to smoking behaviours, respondents endorsing this cumulative risk denial pattern were quite
similar to the average profile, except that were smoking for a longer time (about 23 years
since initiation, and 21 years of daily smoking).
Factors associated with patterns of risk denial among smokers
In bivariate analysis, smokers who rejected risk denial were younger, while those gathered in
the cumulative risk denial profile were older (see Table II). The no risk denial pattern
corresponded to more educated smokers, especially with regard to the fatalism and faith in
medicine profile. This last profile was also characterized by a lower socio-economic status
(with a lower proportion of professionals, managers and owners of a business). Concerning
incentives to risk denial, smokers in the cumulative risk denial profile were more likely to be
attached to their health, to worry about the future and to report conflicts due to smoking in
their household.
In multivariate analysis, we first compared the patterns cumulative risk denial (Cluster 4)
and no risk denial (Cluster 1). Other things being equal, cumulative risk denial was positively
correlated with age, duration since smoking initiation, a lower consumption of cigarettes per
week and a low educational level. Endorsing such attitude was also associated to reporting a
greater preoccupation for their health and for their future. When comparing cumulative risk
denial and fatalism and faith in medicine (Cluster 2), male smokers and those worrying about

Cluster 3

47%
53%
32%
51%
17%
20.0
100
55%
19%
26%
25%
42%
6%
27%
3.49
2.70
1.70

53%
47%
38%
50%
12%
17.3
91
31%
22%
47%
38%
31%
10%
21%
3.43
2.62
1.86

1.76

2.65

3.52

38%
24%
15%
23%

34%
27%
39%

34%
44%
22%
19.2
55

56%
44%

column percentage

Cluster 2

2.02*

3.00**

3.60*

35%
37%
5%
22%***

54%
12%
34%***

20%
49%
31%***
22.6***
73***

58%
42% ns

Cluster 4

NS

1.38 [1.14; 1.66]

1.39 [1.02; 1.96]

NS

2.63 [1.66; 4.18]

1.01 [0.54; 1.89]
1.0

0.43 [0.15; 1.26]

0.48 [0.24; 0.99]
1.0
1.03 [1.01; 1.07]
0.98 [0.97; 0.99]

NS

Cluster 4 vs. Cluster 1

1.38 [1.10; 1.72]

1.25 [1.02; 1.53]

NS

NS

NS

0.32 [0.16; 0.64]

0.53 [0.29; 0.98]
1.0
NS
0.98 [0.97; 0.99]

1.65 [1.03; 2.65]

1.0

odds ratios CI [95%]1

Cluster 4 vs. Cluster 2

1.26 [1.03; 1.55]

1.26 [1.04; 1.54]

NS

1.23 [0.64; 2.34]

1.88 [1.03; 3.42]
0.52 [0.20; 1.35]
1.0

1.47 [0.83; 2.58]

0.52 [0.27; 0.99]
1.0

1.02 [1.00; 1.04]

NS

NS

NS

Cluster 4 vs. Cluster 3

***, **, *, ns, respectively, significant at p 5 .001, p 5 .01, p 5 .05, not significant (Pearsons w2 for proportions, F-ratio test for age and number of years since smoking
initiation, Walds w2 for odds ratios). The symbol NS marks variables not selected by the stepwise procedure.
1
Confidence Interval at the 95% level, using a stepwise logistic regression.
2
Reference group in logistic regression.
3
The baccalaureate marks the completion of the French high school program
4
Last occupation for retired people.

Gender:
Male
Female2
Age:
18 30
31 50
51 752
Number of years since smoking initiation
Number of cigarettes smoked per week
Educational level3:
5Baccalaureate
Baccalaureate
4Baccalaureate2
Occupation4:
Professional/manager/owner of a business
Office worker/clerical
Student/other
Manual worker2
Importance attached to ones health:
1 not important, 4 very important
Worrying about the future:
1 not at all, 4 very much
Conflicts in the household due to smoking:
1 never, 4 frequently

Cluster 1

Table II. Factors associated with patterns of risk denial among cigarette smokers, logistic regressions (ORSIF survey, n 939, 2000)

The moral career of smokers

267

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P. Peretti-Watel et al.

the future or reporting conflicts in household due to smoking were more likely to agree with
risk denial statements, while younger smokers and those reporting a higher number of
cigarettes smoked per week were more likely to endorse the fatalistic perspective.
Finally, smokers worrying about the future or reporting smoking-related conflicts in
household were also more prone to endorse the cumulative risk denial perspective instead of
emphasizing their self-control (Cluster 3) over smoking and its health-related consequences.
In this third logistic model, the duration since smoking initiation and being an office worker
or involved in a clerical work increased the odds to support cumulative risk denial. With
regards to educational level, smokers with a baccalaureate were more prone to endorse the
self-control perspective, especially when compared with those with a lower diploma.

Discussion
Limitations of the present study
Before discussing our results, we must acknowledge some limitations of the present study.
First, our data were derived from a regional survey: they must not be considered to represent
a sample of the global French smoking population. Second, the French health authorities
have launched several anti-tobacco campaigns since the present data have been collected.
Nevertheless, one could assume that these campaigns failed to drastically alter smokers risk
denial, especially since the decrease in smoking prevalence has not been dramatic (Guilbert
et al. 2005). Third, despite a rather high response rate, a participation bias may have been
introduced by the fact that interviewers announced the subject of the survey before asking
people to participate. One could imagine that those smokers who are less comfortable with
their habit and feel unable to justify it were more prone to refuse to participate. Finally, a
closed-ended questionnaire may prevent respondents from qualifying or justifying their
responses then such instrument probably misses some aspects of the smokers moral
perspective that could have been better captured with qualitative methods.
Hypotheses related to the moral career of cigarette smokers
We found four patterns of risk denial among smokers. The larger one corresponded to
rejection of all risk denial statements (no risk denial, 38% of the sample). Smokers in the
second cluster also reject most of these statements, but they were prone to consider that
they have smoked too much to benefit from quitting, and they hope that medicine will
soon cure smoking-related diseases (fatalism and faith in medicine, 18%). The other
patterns were more supportive of risk denial statements. The third one gathered lighter
smokers who were prone to consider they exert some control over their cigarette
consumption and its health-related consequences (self-control, 28%), and the last one
corresponded to cumulative risk denial (16%). Most of our hypotheses were confirmed:
most smokers agreed that smoking damages health and considered being well-informed
about smoking hazards, even among smokers gathered in the self-control and cumulative risk
denial patterns (Hypothesis 1); cigarette consumption varied significantly across risk denial
patterns, with a higher prevalence of occasional smoking among smokers who considered
that they have not smoked long enough or enough cigarettes to be exposed to smokingrelated diseases (Hypothesis 2); cumulative risk denial was positively correlated with smoking
experience, but not with educational level (Hypothesis 3); and smokers who rated their
health and the future as important issues were more prone to endorse the cumulative risk
denial pattern (Hypothesis 4).

The moral career of smokers

269

Of course, the first two hypotheses lacked specificity. Smokers propensity to acknowledge
smoking harmful effects in general, but to claim that they are personally less at risk, is
congruent with psychological interpretations such as optimistic bias, unrealistic optimism
or illusion of control (Weinstein 1989, McKenna 1993); and other studies have already
found a correlation between cigarette consumption level and smoking-related beliefs
(Schoenbaum 1997, Sutton 1999). Hypothesis 3 was more specific but corresponding results
were less convincing, as the more educated smokers were not more prone to cumulative risk
denial. However, reciprocally the lowest educational level did not correspond to the self
control and cumulative risk denial profiles, but to the fatalism and faith in medicine profile.
Moreover, cumulative risk denial was positively correlated to the number of years of
smoking then risk denial cannot be considered as a kind of novice mistake. We expected a
positive correlation between educational level and risk denial because formal education may
provide intellectual training for processing information in order to justify ones behaviour
more convincingly (Jackman and Muha 1984, Phelan et al. 1995). Such relationship has
been found for adolescent cannabis use (Peretti-Watel 2006), but one could assume that less
cognitive sophistication is required for denying the risks of cigarette smoking because the
powerful tobacco industry succeeds in providing smokers with good reasons to keep
smoking. Finally, Hypothesis 4 was also quite specific: among smokers, importance attached
to ones health and worrying about the future were positively correlated to cumulative risk
denial.
What does not kill my denial makes it stronger
Some of our hypotheses and results may seem rather strange in reference to previous studies
comparing smokers and non-smokers, especially in health economics. In this literature,
educated people are expected not to smoke, or to quit more easily, for a variety of reasons:
they are more apt to understand prevention information; education is a strong incentive to
quit (as more education means higher wages and retirement income, which makes a long life
more valuable); and non-smoking and schooling may be both caused by a third variable,
namely self-discipline (Farrel and Fuchs 1982, Sander 1995, Hu et al. 1998). The rational
addiction theory also assumes that future orientation deters from smoking (Becker and
Mulligan 1997, Harris and Harris 1996); and some empirical studies suggested that living
with non-smokers decreases the risk of smoking (Kabat and Wynder 1987, Yen and Jones
1996).
This literature does not necessarily contradict our results. From our perspective,
education, future orientation and living with non-smokers prevent smoking, but those
educated and future-oriented people who live with non-smokers and are nevertheless
engaged in smoking may be more prone to risk denial. This is clearly illustrated by conflicts
in the household due to smoking. There is no doubt that such conflicts are a strong incentive
to quit, but people who are still smoking despite the conflict are probably well-trained to
justify their smoking habit. In other words, to paraphrase Goethe, What does not kill my
denial makes it stronger.
Other aspects of Beckers model of deviance
In the present study, we used quantitative cross-sectional data to focus on smokers moral
career, while Beckers theoretical perspective is diachronic, following the trajectory of a
given individual over time to catch the successive stages of its career. Nevertheless, such
diachronic perspective is not totally absent in our study, as the heterogeneity of our risk

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P. Peretti-Watel et al.

denial patterns may partly reflect the fact that interviewed smokers were situated at various
stages of their moral career. Age is a good indicator of the progression in the smokers
career, as most smokers (70% in our sample) start smoking at age 15 20 years. Figure 1
displays the relationship between age and risk denial patterns. As they grew older, smokers
were increasingly endorsing the cumulative risk denial pattern, while the proportion rejecting
risk denial declined after age 30 39. Moreover the self-control pattern, typical of lighter
smokers, was more frequently endorsed by both younger and older smokers.
Thus one could imagine the following sequence across smokers lifecycle: young smokers
are first light smokers, for who the self-control pattern is especially relevant; as they grow
older, many of them smoke more cigarettes and change their mind regarding risk denial;
then in their thirties some remain heavy smokers prone to support cumulative risk denial
while others succeed in reducing their consumption (for example if they have children and
decide not to smoke at home) and then re-endorse the self-control pattern. Of course further
research is needed to test such speculative interpretation, with longitudinal or retrospective
data detailing variation in consumption across the lifespan.
Moreover, Beckers sequential approach to marijuana use also involves gradual learning
about the products effects: users progressively learn to bring on the effects, perceive them,
enjoy them, and then motives for smoking are modified with use. Similarly, Hughes (2002)
showed that cigarette smokers must acquire the basic skills of smoking (for example:
inhaling the smoke without coughing, exhaling it in a socially correct way) before learning
to control the effects of nicotine and then using it as a psychological tool. Previous studies
demonstrated the heterogeneity of expected benefits of smoking: social facilitation and

Figure 1. Patterns of risk denial according to smokers age.

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271

relaxation, stress relief, weight control, but also construction of a self identity (Waldron
1991, Graham 1994, Benthin et al. 1995, Denscombe 2001, Honjo and Siegel 2003).
Our data gave only indirect insight into smokers motives. Smokers who reject risk
denial were more frequently afraid to get even more stressed if they quit, while smokers
gathered in the fatalism and faith in medicine profile were more prone to report that they
dont want to lose the pleasure of smoking. Further research is needed to investigate
relationships between smokers risk denial and motives. For example, one could assume
that the impetus to deny smoking hazards is weaker for smokers who have stronger
motives (e.g., stress relief instead of pleasure). Smokers motives may also help to explain
an apparent paradox in our survey: among smokers who agreed being slaves to the
cigarette, four out of ten nevertheless claimed that they completely control their cigarette
consumption. They may consider they control it because they know how to use cigarette
as a psychological tool (to pick them up or either to calm them down, see Hughes 2002),
even if it enslaves them.
Conclusion
This study aimed to illustrate the relevance of Beckers model of deviance for understanding
contemporary adult smoking, and especially smokers moral career, with a quantitative
approach making use of a French cross-sectional survey. From this perspective, one crucial
aspect of smoking is smokers ability to develop and entertain convincing patterns of beliefs
that help them to challenge anti-tobacco messages. According to our results, these selfexempting beliefs are closely correlated to cigarette consumption and duration since
smoking initiation and, paradoxically, they may be stronger among smokers who have some
characteristics usually considered as protective factors against smoking. In other words,
what does not kill risk denial may make it stronger. More generally, the sociological
perspective endorsed in this study leads to consider smokers self-exempting beliefs as the
result of acquired cognitive skills instead of the consequences of lack of information or
psychological bias. This is the reason why we believe it provides a promising avenue for
further studies, especially for understanding the difficulties faced by anti-tobacco campaigns
and for improving them.
Acknowledgements
Patrick Peretti-Watels participation in this project was funded by a grant from the National
Institute for Prevention and Health Education (INPES).
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