Across 40 years I’ve come to recognise many factoid-driven myths about smoking that just won’t die. If I asked for a dollar each time I had to patiently refute these statements, I’d have accumulated a small fortune.

Their persistence owes much to their being a vehicle for those who utter them to express unvoiced but clear subtexts that reflect deeply held beliefs about women, the disadvantaged, mental illness, government health campaigns and the “natural”.

Let’s drive a stake through the heart of ten of the most common myths.

​“Women and girls smoke more than men and boys”

Women have never smoked more than men. Occasionally, a survey will show one age band where it’s the other way around, but from the earliest mass uptake of smoking in the first decades of last century, men streaked out way ahead of women. In 1945 in Australia, 72 percent of men and 26 percent of women smoked.1 By 1976, men had fallen to 43 percent and women had risen to 33 percent. As a result men’s tobacco-caused death rates have always been much higher than those of women. Women’s lung cancer rates, for example, seem unlikely to reach even half the peak rates that we saw in men in the 1970s. Currently in Australia, 15 percent of men and 12 percent of women smoke daily.2

But what about all the “young girls” you can see smoking, I’m always being told. In 2014, 13 percent of 17-year-old male high school students and 11 percent of female students smoked.3 In two younger age bands, girls smoked more (by a single percentage point). Those who keep on insisting girls that smoke more are probably just letting their sexist outrage show about noticing girls’ smoking than their ignorance about the data.

​“Quit campaigns don’t work on low socio-economic smokers”

In Australia, 11 percent of those in the highest quintile of economic advantage smoke, compared with 27.6 percent in the lowest quintile.4 More than double. So does this mean that our quit campaigns “don’t work” on the least well-off? Smoking prevalence data reflect two things: the proportion of people who ever smoked, and the proportion who quit. If we look at the most disadvantaged groups, we find that a far higher proportion take up smoking than in their more well-to-do counterparts (60.5 percent vs 49.6 percent have ever smoked5) while when it comes to quitting 66.6 percent of the most disadvantaged have quit compared to 47.7 percent of the least disadvantaged6).

There are more disadvantaged smokers mainly because more take it up, not because disadvantaged smokers can’t or won’t quit. With 27.6 percent of the most disadvantaged smoking today, the good news is that nearly three-quarters don’t. Smoking and disadvantage are hardly inseparable.

​“Scare campaigns don’t work”

Countless studies have asked ex-smokers why they stopped and current smokers about why they are trying to stop. I have never seen such a study when there was not daylight between the first reason cited (worry about health consequences) and the second most nominated reason (usually cost). For example, a national US study covering 13 years showed that “concern for your own current or future health” was nominated by 91.6 percent of ex-smokers as the main reason they quit, compared with 58.7 percent naming expense and 55.7 percent being concerned about the impact of their smoking on others.7

If information and warnings about the dire consequences of smoking “don’t work”, then from where do all these ex-smokers ever get these top-of-mind concerns? They don’t pop into their heads by magic. They encounter them via anti-smoking campaigns, pack warnings, news stories about research, and personal experiences with dying family and friends. The scare campaigns work.

​“Roll-your-own tobacco is more ‘natural’ than factory-made”

People who smoke rollies often look you in the eye and tell you that factory-made cigarettes are full of chemical additives, while roll-your-own tobacco is “natural” – it’s just tobacco. The reasoning here is that we are supposed to understand that it’s these chemicals that are the problem, while the tobacco, being “natural”, is somehow OK.

This myth was first turned very unceremoniously on its head when New Zealand authorities ordered the tobacco companies to provide them with data on the total weight of additives in factory-made cigarettes, roll-your-own and pipe tobacco. For example, data from 1991 supplied by W.D. & H.O. Wills showed that in 879,219 kilograms of cigarettes, there was 1,803 kilograms of additives (0.2 percent) while in 366,036 kilograms of roll-your-own tobacco, there was 82,456 kilograms of additives (22.5 percent)!8 Roll your own tobacco is pickled in flavouring and humectant chemicals, the latter being used to keep the tobacco from drying out when smokers expose the tobacco to the air 20 or more times a day when they remove tobacco to roll up a cigarette.

​“Nearly all people with schizophrenia smoke”

It’s true that people with mental health problems are much more likely to smoke than those without diagnosed mental health problems. A meta-analysis of 42 studies on tobacco smoking by those with schizophrenia found an average 62 percent smoking prevalence (with a range from 14 to 88 percent). But guess which study in these 42 gets cited and quoted far more than any of the others?

If you said the one reporting 88 percent smoking prevalence you’d be correct. This small 1986 US study of just 277 outpatients with schizophrenia has today been cited a remarkable 1,135 times. With colleagues I investigated this flagrant example of citation bias9 (where startling but atypical results stand out in literature searches and get high citations – “wow! This ones got a high number, let’s quote that one!”). By googling “How many schizophrenics smoke” we showed how this percolates into the community via media reports where figures are rounded up in statements like “As many as 90 percent of schizophrenic patients smoke”.

Endlessly repeating that “90 percent” of those with schizophrenia smoke does these people a real disservice. We would not tolerate such inaccuracy about any other group.

​“Everyone knows the risks of smoking”

Knowledge about the risks of smoking can exist at four levels.10 Level 1: having heard that smoking increases health risks. Level 2: being aware that specific diseases are caused by smoking. Level 3: accurately appreciating the meaning, severity, and probabilities of developing tobacco related diseases, and Level 4: personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases.

Level 1 knowledge is very high, but as you move up the levels, knowledge and understanding greatly diminish. Very few people for example, are likely to know that two in three long-term smokers11 will die of a smoking caused disease, nor the average number of years that smokers lose off normal life expectancy.

​“You can reduce the health risks of smoking by just cutting down”

It’s true that if you smoke five cigarettes a day rather than 20 your lifetime risk of early death is less (although check the risks for one to four cigarettes a day here12). But trying to “reverse engineer” the risk by just cutting down rather than quitting has been shown in at least four large cohort studies to confer no harm reduction.13 If you want to reduce risk, quitting altogether is the goal.

​“Air pollution is the real cause of lung cancer”

Air pollution is unequivocally a major health risk. By “pollution” those who make this argument don’t mean natural particulate matter like pollen and soil dusts, they mean nasty industrial and vehicle pollution. The most polluted areas of Australia are cities, where pollution from industry and motor vehicle emissions are most concentrated. Remote regions of the country are the least polluted, so if we wanted to consider the relative contributions of air pollution and smoking to smoking-caused diseases, an obvious question to ask would be “does the incidence of lung cancer differ between heavily polluted cities and very unpolluted remote areas?” Yes it does. Lung cancer incidence is highest in Australia in (wait for this . . .) the least polluted very remote regions of the country, where smoking prevalence happens also to be highest.14

​“Smokers should not try to quit without professional help or drugs”

If you ask 100 ex-smokers how they quit, between two-thirds and three-quarters will tell you they quit unaided: on their final successful quit attempt, they did not use nicotine replacement therapy (NRT), prescribed drugs, or go to some dedicated smoking-cessation clinic or experience the laying on of hands from some alternative medicine therapist. They quit unaided.15 So if you ask the question “What method is used by most successful quitters when they quit?” the answer is cold turkey.

Fine print on an English National Health Service poster states a bald-faced lie by saying that “There are some people who can go cold turkey and stop. But there aren’t many of them.” In the years before16 NRT and other drugs were available many millions – including heavy smokers – quit smoking without any assistance. That’s a message that the pharmaceutical industry would rather not megaphone.

​“Many smokers live into very old age, so it can’t be that harmful”

People who use this argument should probably just wear a badge saying “I’m not very bright” to save us the trouble of having to listen to their interesting theories on disease. In just the way that five out of six participants in a round of deadly Russian roulette might proclaim that putting a loaded gun to their head and pulling the trigger caused no harm, those who use this argument are just ignorant of risks and probability. Many probably buy lottery tickets with the same deep knowing that they have a good chance of winning.