Background: Data on perception of smoking risk amongst the Irish population are sparse.

Aims: To study the accuracy and determinants of the perceived risk of premature death due to smoking in the general population and amongst general practitioners (GPs).

Methods: Telephone surveys of a representative sample of Irish adults (1,247) and GPs (171; 85% response rate) asked participants to estimate how many of 1,000 20-year-old life-long smokers would die from smoking-related disease before the age of 70 and to identify the main cause of death from a list of seven causes: smoking, road traffic accidents, accidents at work, AIDS, homicide, illicit drugs and alcohol misuse.

Results: In the population and GP samples, perception of the risk of smoking-related death was similar (median 200 and 150 deaths per 1,000 smokers respectively, epidemiological estimates 250/1000). Only 43% of the population identified smoking as the most important cause of death compared with 87% of GPs. Current smoking status, younger age, female gender, lower educational attainment and lower income were associated with failure to identify smoking as the main cause of death.

Conclusion: Despite decades of health promotion, the general public underestimates the relative importance of smoking as a cause of death.