{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T03:46:13Z","timestamp":1769312773341,"version":"3.49.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2017,4,6]],"date-time":"2017-04-06T00:00:00Z","timestamp":1491436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P50DA036128"],"award-info":[{"award-number":["P50DA036128"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The majority of smokers regret ever starting to smoke, yet the vast majority continue to smoke despite the fact that smoking kills nearly 50% of lifetime users. This study examined the relationships between regret and smoker characteristics, quit history, risk perceptions, experiential thinking, and beliefs and intentions at time of smoking initiation. Methods: Data from the 2014 Tobacco Products and Risk Perceptions Survey, a nationally representative survey of United States adults, were analyzed to provide the latest prevalence estimates of regret and potential predictors. Relationships among predictor variables and regret were analyzed using correlations, t-tests, and multinomial logistic regression. Results: The majority of smokers (71.5%) regretted starting to smoke. Being older and non-Hispanic white were significant predictors of regret. Smokers having a high intention to quit, having made quit attempts in the past year, worrying about getting lung cancer, believing smoking every day can be risky for your health, perceiving a risk of being diagnosed with lung cancer during one\u2019s lifetime, and considering themselves addicted to cigarettes were significant predictors of regret for smoking initiation. Conclusions: This study provides updated prevalence data on regret using a national sample, and confirms that regret is associated with perceived risk. The findings from this study can be used to inform smoking intervention programs and support the inclusion of smoker regret in cost\u2013benefit analyses of the economic impact of tobacco regulations.<\/jats:p>","DOI":"10.3390\/ijerph14040390","type":"journal-article","created":{"date-parts":[[2017,4,6]],"date-time":"2017-04-06T09:57:30Z","timestamp":1491472650000},"page":"390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Regretting Ever Starting to Smoke: Results from a 2014 National Survey"],"prefix":"10.3390","volume":"14","author":[{"given":"Pratibha","family":"Nayak","sequence":"first","affiliation":[{"name":"Georgia State University\u2019s Tobacco Center of Regulatory Science, Atlanta, GA 30308, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry","family":"Pechacek","sequence":"additional","affiliation":[{"name":"Georgia State University\u2019s Tobacco Center of Regulatory Science, Atlanta, GA 30308, USA"},{"name":"Division of Health Management &amp; Policy, Georgia State University, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Slovic","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Oregon, Eugene, OR 97403, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Eriksen","sequence":"additional","affiliation":[{"name":"Georgia State University\u2019s Tobacco Center of Regulatory Science, Atlanta, GA 30308, USA"},{"name":"Division of Health Management &amp; Policy, Georgia State University, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,4,6]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2008). Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses\u2014United States, 2000\u20132004."},{"key":"ref_2","unstructured":"U.S. Department of Health And Human Services (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Danaei, G., Ding, E.L., Mozaffarian, D., Taylor, B., Rehm, J., Murray, C.J.L., and Ezzati, M. (2009). The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000058"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1056\/NEJMsa1211128","article-title":"21st-century hazards of smoking and benefits of cessation in the United States","volume":"368","author":"Jha","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S341","DOI":"10.1080\/14622200412331320743","article-title":"The near-universal experience of regret among smokers in four countries: Findings from the international tobacco control policy evaluation survey","volume":"6","author":"Fong","year":"2004","journal-title":"Nicotine Tob. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1136\/tobaccocontrol-2014-052022","article-title":"An evaluation of the FDA\u2019s analysis of the costs and benefits of the graphic warning label regulation","volume":"24","author":"Chaloupka","year":"2015","journal-title":"Tob. Control"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1093\/ntr\/ntt032","article-title":"Comparing the experience of regret and its predictors among smokers in four Asian countries: Findings from the ITC surveys in Thailand, South Korea, Malaysia, and China","volume":"15","author":"Sansone","year":"2013","journal-title":"Nicotine Tob. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1080\/09595230701710829","article-title":"What does it mean to want to quit?","volume":"27","author":"Balmford","year":"2008","journal-title":"Drug Alcohol Rev."},{"key":"ref_9","unstructured":"Centers for Disease Control and Prevention (2011). Quitting Smoking among Adults\u2014United States, 2001\u20132010."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1111\/j.1525-1497.2003.20640.x","article-title":"Motivating and helping smokers to stop smoking","volume":"18","author":"Hughes","year":"2003","journal-title":"J. Gen. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Festinger, L. (1962). A Theory of Cognitive Dissonance, Stanford University Press.","DOI":"10.1038\/scientificamerican1062-93"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"481","DOI":"10.7763\/IJSSH.2016.V6.695","article-title":"Understanding cognitive dissonance in smoking behaviour: A qualitative study","volume":"6","author":"Orcullo","year":"2016","journal-title":"Int. J. Soc. Sci. Humanity"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1037\/a0014669","article-title":"Regret and rationalization among smokers in Thailand and Malaysia: Findings from the International Tobacco Control Southeast Asia Survey","volume":"28","author":"Lee","year":"2009","journal-title":"Health Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Slovic, P. (2001). Cigarette smokers: Rational actors or rational fools?. Smoking: Risk, Perception, and Policy, Sage.","DOI":"10.4135\/9781452232652"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1136\/tobaccocontrol-2011-050139","article-title":"Patterns of cognitive dissonance-reducing beliefs among smokers: A longitudinal analysis from the International Tobacco Control (ITC) four country survey","volume":"22","author":"Fotuhi","year":"2013","journal-title":"Tob. Control"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/0306-4603(91)90028-G","article-title":"Cognitive dissonance in tobacco smokers","volume":"16","author":"Mcmaster","year":"1991","journal-title":"Addict. Behav."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1080\/10810730600637343","article-title":"Unrealistic optimism in smokers: Implications for smoking myth endorsement and self-protective motivation","volume":"11","author":"Dillard","year":"2006","journal-title":"J. Health Commun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.ypmed.2004.03.001","article-title":"\u201cBulletproof Skeptics in Life\u201ds Jungle\u201d: Which self-exempting beliefs about smoking most predict lack of progression towards quitting?","volume":"39","author":"Oakes","year":"2004","journal-title":"Prev. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/BF02884459","article-title":"Accuracy of smokers\u2019 risk perceptions","volume":"20","author":"Weinstein","year":"1998","journal-title":"Ann. Behav. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/BF00844942","article-title":"Perceptions of smoking risk as a function of smoking status","volume":"15","author":"Mccoy","year":"1992","journal-title":"J. Behav. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"681","DOI":"10.5993\/AJHB.36.5.10","article-title":"Perceived risk and quitting behaviors: Results from the ITC 4-country survey","volume":"36","author":"Costello","year":"2012","journal-title":"Am. J. Health Behav."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1002\/(SICI)1099-0771(200004\/06)13:2<259::AID-BDM336>3.0.CO;2-6","article-title":"What does it mean to know a cumulative risk? Adolescents\u2019 perceptions of short-term and long-term consequences of smoking","volume":"13","author":"Slovic","year":"2000","journal-title":"J. Behav. Decis. Making"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1126\/science.3563507","article-title":"Perception of risk","volume":"236","author":"Slovic","year":"1987","journal-title":"Science"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/BF00845372","article-title":"Unrealistic optimism about susceptibility to health problems","volume":"5","author":"Weinstein","year":"1982","journal-title":"J. Behav. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1037\/0278-6133.3.5.431","article-title":"Why it won\u2019t happen to me: Perceptions of risk factors and susceptibility","volume":"3","author":"Weinstein","year":"1984","journal-title":"Health Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/BF00846146","article-title":"Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample","volume":"10","author":"Weinstein","year":"1987","journal-title":"J. Behav. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1136\/tc.2004.008375","article-title":"Smokers\u2019 unrealistic optimism about their risk","volume":"14","author":"Weinstein","year":"2005","journal-title":"Tob. Control"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Slovic, P. (2001). Smoking: Risk, Perception, and Policy, Sage Publications.","DOI":"10.4135\/9781452232652"},{"key":"ref_29","unstructured":"U.S. Department of Health and Human Services (2012). Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/13698575.2012.692774","article-title":"The \u201cvalue\u201d of smoking: An editorial","volume":"14","author":"Slovic","year":"2012","journal-title":"Health Risk Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/1467-8721.00203","article-title":"Regret in decision making","volume":"11","author":"Connolly","year":"2002","journal-title":"Curr. Directions Psychol. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1348\/135910705X40997","article-title":"Role of anticipated regret, intentions and intention stability in adolescent smoking initiation","volume":"11","author":"Conner","year":"2006","journal-title":"Br. J. Health Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.3109\/10826084.2016.1160123","article-title":"Exploring relationships among experience of regret, delay discounting, and worries about future effects of smoking among current smokers","volume":"51","author":"Thrasher","year":"2016","journal-title":"Subst. Use Misuse"},{"key":"ref_34","unstructured":"GfK (2013). Knowledgepanel\u00ae Design Summary, GfK."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1080\/14622200802238886","article-title":"Association of retrospective early smoking experiences with prospective sensitivity to nicotine via nasal spray in nonsmokers","volume":"10","author":"Perkins","year":"2008","journal-title":"Nicotine Tob. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.addbeh.2004.08.001","article-title":"Validation of retrospective reports of early experiences with smoking","volume":"30","author":"Pomerleau","year":"2005","journal-title":"Addict. Behav."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/4\/390\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:32:07Z","timestamp":1760207527000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/4\/390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,6]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,4]]}},"alternative-id":["ijerph14040390"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14040390","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,6]]}}}