Background:
Overall, Serbian adults are aware of the association of smoking with malignant diseases. However, it is not known whether adult smokers perceive this a risk for future concern. The study objective is to understand how smoking related opinions and risk perception in Serbian adults is associated with smoking status in order to support planning of targeted interventions.

Methods:
Secondary analysis of data drawn from a 2014 cross sectional, National Survey on Lifestyles of Citizens in Serbia. Multivariate logistic regression was used to determine the association of smoking opinions and risk perception with smoking status.

Results:
A total sample of 5385 adults aged 18-64 years were analysed with a smoking prevalence of 39.8%. Tobacco use ranked 15^th of 17 listed problems in Serbia by its perceived importance. Opinions on tobacco use as a problem significantly differs by smoking status (p< 0.001, χ2=90.04). Among those (75.5%) who report tobacco use as rather important or an important problem, 44.5%, are non-smokers, 36.5% are current smokers and 19.1% ex-smokers. There is also a significant difference (p< 0.05, χ2=329.22) in risk perception according to smoking status, 66.5% of adults perceived smoking one or more packs of cigarettes per day to be great risk, of which 48.9%, are non-smokers 31.7% are smokers and 19.4% are ex-smokers. Those who think tobacco is an important problem compared with people who think it is not a problem (OR 1.6, p< 0.001) and those who perceive smoking as not risky (OR,7.0, p< 0.001) compared with those who think it is a great risk, have higher odds of being smokers.

Conclusions:
Despite high prevalence, smoking is not recognized as important problem in society. Among current smokers, risk perception is low. Findings call for interventions aimed at changing risk perception and opinions on importance of tobacco control.