Addtctivr Behaviors, Vol. 2. pp. 129-134. Pergamon Press 1977.

Prmted m Great Br~tam

SMOKING AS A SUBJECTIVELY RATIONAL CHOICE

J. RICHARD EISER and STEPHEN R. SUTTON

Addiction Research Unit, Institute of Psychiatry, 101, Denmark Hill. London. SE5 8AF. U.K

Abstract-h order to identify variables which might influence adult smokers to attempt to
give up smoking, questionnaires were distributed to a final sample of 45 public employees
who were-cigarette smokers. These offered subjects the chance to apply for treatment at a
nearby smokers’ clinic and also asked questions about their own smoking history. their perceived
dependence on smoking, their perceptions of utilities associated with continuing smoking or
attempting to stop smoking and succeeding or failing in the attempt. Of the 45 subjects, 18
chose to apply for treatment, and a discriminant analysis was performed to see if these could
be distinguished from the 27 “non-choosers” in terms of their questionnaire responses. The
most important predictor was the number of cigarettes smoked per day, with choosers on average
smoking over 30 and non-choosers under 18 per day. In addition, choosers tended to be slightly
older, and enjoy the activity of smoking less than non-choosers. Non-choosers, as compared
with choosers, were relatively confident in their own ability to stop smoking without help.
if they wanted to. Although subjects as a whole tended to rate the overall consequences of
continuing to smoke as worse than the overall consequences of successfully stopping, this was
not an important predictor of which subjects chose to apply for treatment.

INTRODUCTION

In attempting to explain people’s indulgence in a form of behaviour which is clearly

injurious to health, it is perhaps not surprising that many researchers seem to have
favoured approaches that emphasize differences between smokers and non-smokers in
terms of social upbringing (Bynner, 1969) or personality (Eysenck, 1965) or stress the
addictive effects of nicotine (Russell, 1976) to the relative neglect of the questions of
how an individual decides to become, remain, or try to give up being a smoker. As
Aronson (1972, p. 9) has put it, “people who do crazy things are not necessarily crazy”,
and there is a danger of assuming that behaviour which we see as producing negative
consequences cannot be the outcome of decision-making processes which are subjectively
rational, at ‘least within the context of what the smoker regards as personally important.
This study is therefore a preliminary attempt to see how adequately smokers’ decisions
can be predicted from a knowledge of their history of tobacco use, and of their own
evaluations of their behaviour. We shall concentrate on a single decision made within
a specific situational context-namely, whether adult smokers will or will not accept
an invitation to apply for treatment at a smokers’ clinic with a view to giving up
smoking.
Previous research on smokers’ decisions to stop or continue smoking have taken
as their starting point a consideration of the positive and negative consequences which
smokers expect to follow from each course of action. and of the subjective probabilities
associated with such expectations. For example, Mausner & Platt (1971) calculated
smokers’ “subjective expected utilities” (SEUs) for stopping smoking and for continuing
to smoke, and found partial confirmation of their prediction that the higher a person’s
SEU for stopping smoking as compared with his SEU for continuing to smoke, the
greater would be the chance of his deciding to stop smoking. They also found, however.
that, among smokers, the SEU for stopping smoking is more positive than that for
continuing to smoke-a result which focusses attention on the paradox of the “dis-
sonant” smoker (McKennell & Thomas, 1967).
Similar notions are also prominent in the argument, put forward by Rogers (1973,
that the effectiveness of a communication is related not just to its ability to make
people believe that negative consequences are more likely to occur as a result of a
particular course of action (e.g. continuing to smoke), but also to the perceived efficacy
of a recommended protective response (e.g. stopping smoking). Janis (1959) and Janis
& Mann (1968) have also proposed a “balance sheet” model of decision-making in which
129
I30 J. RKHARU Elsm and STCPHCN R. SL~TTOF

the individual’s decision to adopt a particular course of action is seen as depending

on the relative strength of the anticipated positive and negative consequences associated
with the alternative courses of action.
Whilst these lines of research have led to valuable observations, however. neither
has explored any of the wider implications of an SEU approach. In the first place,
the structural correspondence between smokers’ decisions to continue or stop smoking
and the “choice dilemmas” of risk-taking research has been largely ignored. Kogan
& Wallach (1964) conceived of a “choice-dilemma” as a situation in which a person
is faced with a choice between two alternative courses of action-a “cautious” alternative
which is certain to produce consequences of moderate utility, and a “risky” alternative
which would produce more positive consequences if it succeeded and more negative
consequences if it failed. Unfortunately, their purpose is constructing a questionnaire
containing descriptions of such dilemmas was primarily to devise a measure of a gencr-
alized trait of “risk-taking”. for which later research has failed to find corroboration
(Cartwright, 1971). Whereas Mausner and Platt refer to the Kogan and Wallach work.
and profess themselves to be sceptical concerning the notion of the “personality of
the smoker” (p. 55), they nonetheless attempt to use the Kogan and Wallach test to
look for differences between smokers and non-smokers, and among smokers, in their
predispositions to take the risks in general (pp. 67-68). The intuitive assumption here
is that smoking is dangerous, and therefore “risky”. We would suggest however. that
a more counter-intuitive approach may have greater heuristic value-namely to view
a smoker’s decision to continue smoking as the ctrufious alternative in his “choicc-
dilemma”. The reason for this is that the choice facing a smoker is not typically one
of continuing to smoke or stopping, but of continuing to smoke or tr~,irly to stop.
If a smoker tries to give up he may succeed or fail in the attempt. In the context
of a purely formal correspondence between this decision and a choice-dilemma, therefore.
the option of tr~iny to give up smoking may plausibly be considered as a “risky” deci-
sion, with different utilities dependent on its success or failure.
Recent SEU approaches to decision-making have also tried to take into account
factors other than the extrinsic. rewards and costs associated with the consequences
of alternative courses of action. Vinokur, Trope & Burnstein (1975) have introduced
the notion of “action utilities” to take account of the extent to which a given course
of action may be seen to carry intr~in.sic rewards or costs (e.g. en.joyment or excitement).
regardless of its consequences. Another aspect of such intrinsic utilities may be any
over-riding ethical considerations (Eiser, 1976)-a factor which may have greater rele-
vance to the issue of smoking than might at first sight be supposed (Eisinger. 1971).
This distinction between e.xtrirzsic and intrimic utilities is incorporated in this study.
It is therefore in terms of such a “broader” SEU approach that WC shall attempt
to make sense of smokers’ decisions in the specific context mentioned. At the same
time, an attempt is made, through questions about subjects’ smoking history, to accom-
modate within such an approach a consideration of the strength of the habit which
the smoker is invited to try and break.

METHOD

Completed questionnaires were obtained from 45 manual and non-manual employees

of South Eastern Gas (Inner London District) who were cigarette smokers. They in-
cluded 39 men and 6 women, and their ages ranged from 17 to 60, around a mean
of 38.6 years. Two pipe smokers and two cigar smokers also returned questionnaires
but were excluded from the analysis as were 12 others who returned incomplete question-
naires. This represented the total number of returns from approximately 75 question-
naires distributed to smokers only by supervisory staff at South Eastern Gas during
November and December. 1975. One reason for the choice of this sample was that
 Smoking as a subjectively rational choice 131

their homes or places of work would be reasonably near the Maudsley Hospital, should
they opt for treatment at the Smokers’ Clinic.

The questionnaire
The questionnaire, designed for completion by smokers only, contained questions
concerning subjects’ smoking behaviour and their reasons for continuing to smoke or
trying a course of treatment at a smokers’ clinic, and concluded with an invitation
to apply for (free) treatment at the Maudsley Hospital smokers’ clinic. In the written
instructions, it was repeatedly stressed that the aim was “not to persuade more people
to come for treatment, but to find out why some people want to and others do not”.
The questions fell into the five categories, summarized in Table 1.

RESULTS AND DISCUSSION

Of the 45 cigarette smokers, 18 (including 1 woman) indicated that they were interested
in attending the smokers’ clinic. These will be termed choosers. The remaining 27 will
be termed non-choosers. The main question examined was the extent to which choosers
and non-choosers could be reliably distinguished in terms of their questionnaire re-
sponses. A second, but related question was the extent to which these responses were
predictable from a simple measure of consumption-the number of cigarettes subjects
reported usually smoking in a day.
As a first step. mean scores were calculated for the choosers and non-choosers on
each of the questionnaire items, and each pair of means was compared in a series of
separate t-tests (ignoring at this stage any interdependence between the different items).
In addition, the scores for each item were correlated, over all 45 subjects, with reported
cigarette consumption.
As may be seen from Table 1, choosers smoked considerably more, and also inhaled
more than non-choosers. They also perceived themselves as more dependent on smoking
in that they felt it would be more difficult for them to stop smoking temporarily
or permanently, and they felt they smoked less for pleasure than to satisfy a need.
Choosers and non-choosers did not differ significantly (on these t-tests) in their percep-
tions of either the extrinsic or intrinsic utilities relevant to their decision, with the
exception that choosers were more prepared to say that anti-smoking treatment was
something smokers “ought” to try. It is noteworthy that 34 of the 45 subjects (12 of
them choosers) rated the overall consequences of succeeding in stopping smoking more
positively than the overall consequences of continuing to smoke, whereas only 5 subjects
(curiously, 4 of them choosers) rated the consequences of continuing more positively
than the consequences of succeeding in stopping (Chi-square = 21.56, Ilf‘= 1, p < 0.001).
Choosers, as would be expected, were keener to stop smoking, and keener to try
treatment than non-choosers. They were also prepared to accept a lower chance of
treatment succeeding than were non-choosers. For choosers, the chance of treatment
succeeding, though perceived as low, was on average higher than the minimum accept-
able odds, whereas non-choosers rated the actual chance of success of treatment as
lower than what they regarded as minimally acceptable.
These results therefore portray the chooser, in comparison to the non-chooser, as
a heavy smoker who perceives himself to be dependent on smoking, and who estimates
that he has little chance of succeeding in giving it up without professional help. The
number of cigarettes smoked per day was in fact significantly related to all measures
which showed significant differences between choosers and non-choosers. These measures
cannot therefore necessarily be considered as important predictors of choice indepen-
dently of consumption. The effects of other variables also may have been masked by
the consumption measure. For these reasons, to determine how the various measures,
in combination, could be used to predict which subjects would choose to apply for
treatment, a step-wise discriminant analysis was performed, including all measures listed
in Table 1 under “Smoking History” (including age), “Perceived-Dependence”, and
“Intrinsic Utilities”. “Extrinsic utilities” and the probability estimates were combined
132 J. RICHARD EISER and STEPHEN R. SUTTON

Table I. Mean scores for “choosers” and “non-choosers” on each item. and correlation between subjects’
scores on each item and the number of cigarettes smoked per day

r for
Mean for Mean for correlation
choosers non-choosers with cigarettes
(>Y = 18) (Iv = 27) t(df‘= 43) per day

I. Smoking history
(a) No. of cigarettes smoked per day 30.72 17.59 4.60: 1.00
(b) Age (years) 40.28 37.48 0.74 -0.32*
(c) How many years smoked at least
present amount 13.11 15.96 - 0.77 -0.37*
(d) Age started smoking at least I cigarette
per day 15.(X) 16.44 - I .68 ~ 0.4ot
(el Amount Inhaled (I = not at all.
4 = a lot) 3.33 2.70 2.49* 0.561
(f) Time of first cigarette after waking
(I = less than I min. 6 = over I hr) 3.72 4.59 - I .68 -0SOP

2. Perceived dependence
(g) Difficulty of giving up for I week
(0 = extrcmcly easy. IO = extremely
difficult) x.17 5.33 2.72t 0.72:
(h) Difficulty of giving up completely
(0 = extremely easy. IO = extremely ditticult) x.39 6.1 I 2.44* 0.6 1:
(i) How often feel craving if cannot smoke
(0 = never, 10 = always) 6.39 4.96 1.32 0.60:
(i) Smoke typically for pleasure = 0. or to
satisfy a need = IO 1.72 4.89 3.181_ 0.43t
(k) Feel able to control amount smoked
(0 = not at all. IO = completely) 5.44 6.78 - I.29 -0.32*

3. Extrinsic utilities (contingent on success/failure

at giving up)
(I) Overall consequences of continuing to
smoke (0 = extremely bad, IO = extremely
good) 4.50 4.74 - 0.29 -0.15
(m) Overall consequences of succeeding m
giving up 6.94 7.70 -0.86 0.05
(n) Overall consequences of trying to give
up but failing 3.94 3.89 0.08 - 0.06
(0) How would feel personally if succeeded 9.06 7.96 I .43 0.33*
(p) How would feel personally if failed 3.06 3.52 -0.61 -0.01

4. Intrinsic utilities (not contingent on success/failure

at giving up)
(q) How enJoyable activity of smoking
(0 = extremely unenjoyable, IO = extremely
cn.joyable) 6.44 7.44 - 1.46 0.18
(r) How enJoyable think treatment would bc
(0 = extremely uncn.joyablc, IO = extremely
enjoyable) 4.22 3.96 0.33 0.05
(s) Agree that smoking “wrong” (0 = not at
all, IO = very much indeed) 5.39 3.x9 1.53 -0.01
(t) Agree that smokers “ought” to try
treatment X.50 5.78 2.X1? 0.31

5. Probability estimates. etc.

(u) Would try treatment only if chance of
success was at least...in I(& 3.39 7.89 -4.63f -0.491
(v) Actual chance of treatment succeeding
as...in IO 4.06 4.93’. -0.98 -0.17
(w) Chance of stopping without treatment
if want to estimated as...in 10 3.00 6.Y3 - 3.69f -0.47$
(x) How keen to stop permanently (0 = not at
all. IO = very much indeed) X.56 4.19 4.961 0X$
(y) How keen to try treatment (0 = not at all.
IO = very much indeed) 8.00 2.74 6.23f 0.64f

*p< 0.05; t [’ < 0.01 : : p < 0.001.

$ Additional response category: I I = would not take treatment under any circumstances.
 Smoking as a subjectively rational choice 133

multiplicatively to represent the extent to which the extrinsic utilities were perceived
to be more likely consequences of treatment. The method used was that which maxi-
mized Rao’s V (Nie et ul., 1975).
In view of the very unfavourable ratio of subjects to predictors, this analysis should
be considered as providing only very global indications of which predictors might prove
important in subsequent research, rather than any definitive solution. Nonetheless, it
is noteworthy that 39 out of the 45 subjects could be correctly classified on the basis
of only 3 variables, each of which produced an improvement in discrimination between
the two groups (i.e. an increase in Rao’s V) which was significant beyond the O.lO,,
level. These were (in the order in which they were entered) the number of cigarettes
smoked per day, the enjoyment of the activity of smoking, and the subjects’ age, so
that smoking more cigarettes, enjoying smoking less, and being older were predictive
of choosing to apply for treatment. The importance of the enjoyment of activity of
smoking (item q) is interesting in view of its non-significant r-value in the earlier analysis
which did not take account of the interrelationships between the different items.
Moreover, the importance of this item is in striking contrast to the lack of discrimi-
nation provided by measures based on item 1, which should be especially influenced
by subjects’ concern about the dangers to their health. It is conceivable that item 1
may have discriminated better between choosers and non-choosers if it had been worded
as to focus more explicitly on perceived risks to health rather than on “overall conse-
quences”, but this cannot be resolved from the present data.

CONCLUSIONS

It should be pointed out that we were dealing here with only a very minimal indication
of interest in receiving treatment for smoking. Ideally, it would have been interesting
to predict success at stopping from the variables considered in this study. However,
special circumstances (the threat of redundancies among the subject population, and
the intervention of Christmas and New Year holidays between the time of the adminis-
tration of the questionnaire and when treatment could reasonably begin) led us to
postpone such evaluation for later research. In fact, only 3 of the 18 “choosers” came
to the clinic for their first interview, of whom one decided immediately not to attend
further, one took treatment but failed to give up permanently and one succeeded in
becoming a non-smoker. Conceivably more persistent recruitment attempts might have
encouraged more “choosers” to follow up their initial interest, but the validity of our
distinction between groups of smokers is less behaviourally based than that used, for
instance, by Mausner & Platt (1971). For present purposes it is best to interpret our
study as distinguishing only those smokers who had some preliminary interest in treat-
ment from those who had no such interest whatsoever. Furthermore, these data should
not be taken as directly relevant to the issue of why some smokers try to give up,
and may succeed, without any offer of treatment.
On average, non-choosers smoked far fewer cigarettes, were younger, enjoyed their
smoking more and felt that, if they wanted to, they could give up easily enough without
assistance. We submit that, in terms of these subjects’ own perceptions of their situation,
smoking was as “subjectively rational” a choice as the decision taken by the choosers
to express interest in a course of treatment in which their confidence was no more
than mediocre. It may, of course, be that the non-choosers would never get around
to stopping smoking, even though they think they could and objectively may be able
to do so more easily than the more “addicted” choosers. In describing their decision
as subjectively rational, we are neither condoning nor condemning it. We are simply
suggesting that the decisions which smokers make about their smoking are essentially
similar to the decisions people generally make about their behaviour. Any decision
can appear “irrational” to an outsider who does not appreciate its subjective context.
To understand the reasons for smokers’ behaviour, therefore, one must first identify
those factors which smokers themselves regard as most important.
134 J. RICHARD EISER and STEPHEN R. SUTTON

REFERENCES
Aronson. E.. The Sociul Animal. San Francisco: W. H. Freeman, 1972.
Bvnner, J. M.. The Yountr Smoker. Government Social Survev. London: H.M.S.O. 1969
Cartwright. D., Risk taking by individuals and groups: An assessment of research employing choice-dilemmas.
Jotdrr~ul of Prrsonulify und Social Psyclzology, I97 I, 20, 36 l-378,
Eiscr, J. R.. Evaluation of choice-dilemma alternatives: Utility, morality and social -iudeement.
_ &iris/~ Journul
of Sociul md Cliniccll Psychology, 1976, 15. 51-60. - -
Eisinecr. R. A.. Psvchosocial uredictors of smoking recidivism. Journal of’ Hmlth md So&l ErhatGur. 1971.
i2. 3555362. .
Eysenck, H. J.. Smokin(q. Hvulth and Personul~t);. New York: Basic Books, 1965.
Janis. 1. L.. Motivational factors in the resolution of decisional conflicts. In M. R. Jones (Ed.) Nehrusku
Svtqmsiun~ on Motivation, Vol. 7, Lincoln: University of Nebraska Press, 1959.
Janis. 1. L., & Mann L.. A conflict-theory approach to atiitude change and decision-making. In A. G. Green-
wald, T. C. Brock and T. M. Ostrom (Eds) Psvcholouicul Foundations of Attitudes. New York: Academic
Press, 1968.
Kogan. N. & Wallach, M. A.. Risk Tuking. New York: Holt, Rinehart & Winston, 1965.
Mausner. B.. & Platt. E. S., Smoking: A Behuoioral Analysis. New York: Pergamon Press. 1971.
McKennell. A. C., & Thomas, R. K., Adults’ and Ad&scents Smoking Habits and Attitudes. Government
Social Survey, London: H.M.S.O., 1967.
Nie. N. H., Hull, C. H.. Jenkins. J. G., Steinbrenner, K., & Bent, D. H., Stnristicul Package fiv the Social
Scimces. 2nd Edition. New York: McGraw-Hill, 1975.
Rogers. R. W.. A protection-motivation theory of fear appeals and attitude change. Journul of P.sycho/og~,
1975. 91, 93 114.
Russell, M. A. H.. Tobacco smoking and nicotine dependence: In R. J. Gibbins c’t al. (Eds.) Rt,srurch Adcunce.s
irl il/cohol und Drug Prohlerm. Vol. 3. New York: Wiley, 1976.
Vinokur. A.. Trope. Y., & Burnstein, E.. A decision-making analysis of persuasive argumentation and the
choice-shift effect. Jourrlal of E~puimentul Socic~l Psychology, 1975, 11. I27- 14X.