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Stigma and Smoking: The Consequences of Our Good Intentions
Abstract
Smoking has become increasingly socially unacceptable in the United States, and the change coincides with a decline in tobacco use. This growing social unacceptability raises an important new question: Do people who smoke think they are stigmatized? Stigmas may function as a source of social control, contributing to smokers' decisions to quit in order to avoid stigmatization and social exclusion. However, smoker-related stigmas may have counterproductive consequences for smokers if stigmas encourage secrecy and social withdrawal from nonsmokers. This study, based on a random survey of smokers in New York City, provides new measures of perceived devaluation, perceived differential treatment due to smoking, social withdrawal from nonsmokers, and concealment of smoking status. Forty-four percent perceive devaluation and 17 percent report experiencing differential treatment due to smoking. In short, the results suggest that the stigmatization of smokers is a potentially powerful and unrecognized force, one that may have counterproductive consequences.
... 22,23 On the other hand, smoking stigma internalization and self-perceived smoking stigma appear to correlate with increased quit attempts, intentions to quit, and/or smoking-cessation success. 4,18,[24][25][26] Overall, the extant research on the negative effects of smoking stigmatization appears to question the ethical defensibility and future viability of tobacco regulatory strategies that denormalize/stigmatize smoking. 27,28 However, the research conducted to date that investigates tobacco social denormalization and its hypothesized beneficial and iatrogenic effects has been conducted using ad hoc, single-item or two-item instruments of unknown reliability and construct validity; 7 and the few times that multi-item measures were used, 29,30 these had substantive the ISMI was rather arbitrary and one of the three factors only has two items (when it is broadly accepted that a minimum of 3 items is necessary to represent any one factor). ...
... 62 Thus, we hypothesized that non-Hispanic black and Hispanic participants would report higher levels of self-stigma than non-Hispanic white participants. Given that self-stigma and psychological distress are robustly and positively correlated, 59 and that smokers with longer and more intense smoking histories might be more exposed to smoking stigmatization, 26 we compared SSSQ scores between minority and non-A c c e p t e d M a n u s c r i p t minority participants while controling for self-reported symptoms of depression (k6 scores) and ...
... The positive association between AUTOS scores and SSSQ scores is congruent with the expectation that individuals with longer smoking histories and who smoke at higher rates would also have greater exposure to, and be affected more by, smoking denormalization and smoking stigmatizing policies and events 26 Although the three stigma facet scores were strongly intercorrelated, multiple regression analysis revealed that all three subscale scores emerged as unique predictors of motivation to quit. ...
Introduction:
Researchers have become increasingly concerned with the stigmatizing impact that regulations and policies aimed to curve down cigarette smoking may have in smokers. Given the lack of psychometrically validated tools available to assess smoking stigma, we developed and evaluated the Smoker Self-Stigma Questionnaire (SSSQ).
Methods:
A total of 592 smokers recruited through Amazon's Mechanical Turk (MTurk) completed an online, Qualtrics survey that included 45 items developed and vetted by tobacco-research experts. The items were assigned a priori to three, theoretical stigma factors or domains (enacted, felt, and internalized). We first conducted a confirmatory factor analysis (CFA) on the responses from one-half of the participants with the goal of distilling the 45-item pool to an 18-item instrument with 6 items per factor. A promising, 18-item, three-factor measure was then cross-validated with the second half of the sample.
Results:
The second CFA yielded excellent fit indices, as well as adequate and significant factor loadings. Subscale scores obtained from the separated factors differentially predicted nicotine dependence and motivation to quit cigarettes, providing convergent and discriminant validity for the SSSQ and its proposed, three-factor structure.
Conclusions:
Overall, the SSSQ fills an important research gap by providing a psychometrically sound measure that investigators can use to study smoking stigma.
Implications:
Prior research on smoking self-stigma has used a wide variety of psychometrically invalid measures and reported inconsistent findings. This is the first study that presents a measure of smoking self-stigma that is not a merely and arbitrary adaptation of a mental illness stigma measure, but that is theoretically driven and created from a large and comprehensive pool of items vetted by tobacco-research experts. Having demonstrated and then cross-validated its excellent psychometric properties, the SSSQ provides the field with a promising tool to assess, investigate, and replicate the causes and effects of smoking self-stigma.
... The stereotyping of smokers may also be a consequence of the denormalization of smoking. Stuber et al. showed that 38% of smokers who were interviewed reported feeling that, overall, people 'think less' of someone who smokes [21]. This negative image is associated with undesirable characteristics that reduce a person's status in the eyes of the people who stigmatize them [6,7,[21][22][23]. ...
... Stuber et al. showed that 38% of smokers who were interviewed reported feeling that, overall, people 'think less' of someone who smokes [21]. This negative image is associated with undesirable characteristics that reduce a person's status in the eyes of the people who stigmatize them [6,7,[21][22][23]. Such stereotypes may also apply to adolescent smokers [24][25][26]. ...
... Our findings indicate that less stigmatization was felt by adolescents who smoked, adolescents whose academic performance was poor, and those who had friends who smoked. This might be consistent with the concept of 'smoking islands', i.e. cohesive socioeconomically disadvantaged groups in which smoking is more accepted, either due to a sense of active resistance or because people in these groups feel powerless to quit smoking [21]. Our findings suggest that adolescents who smoked felt the effects of stigmatization less in low-SES schools than in high-SES schools, regardless of the impact of STPs. ...
The increasing denormalization of smoking by tobacco control policies and a normative smoke-free climate may shift power towards adolescent non-smokers. It is unclear, however, how common stigmatization of smokers is among adolescents or how stigmatization relates to the denormalization of smoking in their school and social environment. This paper aims to measure (1) whether stigmatization among European adolescents varies according to smoking status and socioeconomic position (SES), and (2) whether stigmatization is greater in school environments in which smoking is denormalized (i.e. those with low smoking rates and strong school tobacco policies). Data on 12,991 adolescents were collected in 55 schools in seven European countries (SILNE R-survey, 2016/17). We applied Stuber’s adapted scale of perceived stereotyping and discrimination towards smokers to smoking status and five variables indicating a power shift towards non-smokers: the school’s tobacco control policy (STP) score, the percentage of adolescents in the school who smoke, parents’ level of education, students’ academic performance, and the percentage of their friends who smoke. Multilevel regressions were applied to the global score for perceived stigmatization. Discrimination against smokers and stereotyping of smokers were frequently reported. Smokers reported less ‘perceived stigmatization of smoking’ than non-smokers (Beta = -0.146, p < 0.001). High-SES students reported stereotyping and discrimination more frequently than lower-SES students. The perception of stigmatization was lower among students whose academic performance was poor (Beta = -0.070, p < 0.001) and among those who had friends who smoked (Beta = -0.141, p < 0.001). Stigmatization was lower in schools with greater exposure to smoking and was not associated with the school’s STP score. Perceived stigmatization of smoking is common among European adolescents. Smokers themselves, however, perceive stigmatization less often than non-smokers. Strong school tobacco policies do not increase stigmatization, but a social environment that is permissive of smoking decreases perceived stigmatization.
... Cultural or societal factors may have a greater in uence on non-cigarette tobacco product consumers than health risks (32). Literature demonstrates that the stigma surrounding tobacco use can signi cantly in uence behavior (33). For instance, research has shown that a notable percentage of individuals feel devalued or experience differential treatment due to their smoking habits. ...
... For instance, research has shown that a notable percentage of individuals feel devalued or experience differential treatment due to their smoking habits. These ndings underscore the powerful, yet often overlooked, impact of societal attitudes towards smokers (33). In summary, our study indicates that societal attitudes, coupled with concerns about health risks and social stigma, play pivotal roles in shaping individuals' decisions regarding NCSTP use. ...
Background
Pakistan has over 30 million active adult smokers, making it one of the most vulnerable low-and middle-income nations. The problem deepens with the popularity of non-cigarette smoked tobacco products (NCSTPs) such as cigars, pipes, and shisha. While studies have been conducted evaluating regular cigarette usage, there is a gap in literature exploring other means of smoked tobacco in these regions. Our study aims to analyze the public’s knowledge, attitudes, and patterns of usage regarding NCSTP.
Methods
Using an online questionnaire, we conducted a nationwide web-based cross-sectional survey in Pakistan. Convenience sampling was used to disseminate and validate the questionnaire. The participants' knowledge, attitudes, and use of NCSTP were evaluated using this questionnaire. The responses of the participants were described using descriptive statistics, and SPSS Version 26 was used to perform logistic regression at a p-value of less than 0.05.
Results
In our sample of 1195 respondents with a mean age of 33 years, 93.3% of respondents had heard of NCSTP before with 57.1% believing they contained both tobacco and nicotine. 45.1% disagreed when asked if NCSTP are exclusively for adults. Removal of stress (29.8%) was the most cited motivator for use while negative health effects (61.4%) was the most selected deterrent. The vast majority of respondents (86.6%) who had used NCSTPs were also users of conventional cigarettes. On accounting for demographic and other variables, our regression analysis revealed that appetizing flavors (OR: 1.788, p = 0.006) and usage as cigarette alternatives (OR: 2.623, p = 0.000) were the two factors significantly associated with usage. On the other hand, social stigma (OR: 0.576, p = 0.004), bad taste (OR: 0.663, p = 0.018), and environmental pollution (OR: 0.493, p = 0.000) were the deterrents significantly associated with decreased usage.
Conclusion
Our findings demonstrate the varied knowledge, attitudes, and usage patterns regarding non-cigarette smoked tobacco products (NCSTP) among participants in an LMIC. Despite a high level of awareness, misconceptions persist regarding their contents and associated risks. While a substantial proportion of the participants have experimented with NCSTPs, the majority have not, citing deterrents such as health concerns and social unacceptability playing significant roles. Notably, the appeal of flavors and the potential for stress relief emerged as the most prevalent motivating factors among users. These insights emphasize the importance of comprehensive strategies aimed at both discouraging use and promoting accurate knowledge about NCSTP.
... A number of interviewees even stated that these characteristics of the course were 'the key to its success' . However, people who smoked heavily seemed to be labeled negatively and positioned -even physically-as an outgroup, which likely contributes to a stigmatized status [19,20]. None of the interviewees was requested to leave, such that we are uncertain how these people responded, but previous research into stigma suggests that they may hide their smoking status from healthcare professionals, family and friends, become angry or feel victimized, all of which decrease the odds of a successful quit attempt [19]. ...
... However, people who smoked heavily seemed to be labeled negatively and positioned -even physically-as an outgroup, which likely contributes to a stigmatized status [19,20]. None of the interviewees was requested to leave, such that we are uncertain how these people responded, but previous research into stigma suggests that they may hide their smoking status from healthcare professionals, family and friends, become angry or feel victimized, all of which decrease the odds of a successful quit attempt [19]. Although it can be questioned whether the approach is ethical, the confrontation with other attendees triggered identity processes towards quitting smoking. ...
Background
Smoking prevalence is still high, which requires effective interventions that help many people who smoke at once in addition to time-consuming individual interventions. ‘I Quit’ is a large-scale smoking cessation course in The Netherlands. This qualitative study explored I Quit participants’ experiences during and after the course, and perceptions of whether and how the course may have altered their smoking behavior.
Methods
We performed individual semi-structured interviews with course participants (N = 21) who had either quit successfully, attempted to quit but relapsed, or had continued to smoke after ‘I Quit’. Shortly after qualitative data collection was completed, Foundation I Quit was accused in the media of a number of misbehaviors. Although unplanned, this provided a unique opportunity to explore participants’ views on alleged fraud in a second round of interviews (N = 16). Data were collected from 2016 to 2018.
Results
Qualitative findings showed two psychosocial processes that may explain smoking cessation after course attendance. First, the confrontation with a large group of people who smoke, of whom some had already developed smoking-related complaints, triggered identity processes both towards and away from quitting smoking. Unorthodox methods used in the course appeared to trigger identity processes. Second, social support after the course from participants’ own social network facilitated maintenance of successful quitting. The study also found that interview participants’ opinions on I Quit did not change much after allegations of fraud in the media.
Conclusions
Findings suggest that a one-time course might initiate psychosocial processes that could help certain smokers to gain motivation to quit, requiring a minimum of resources. Identity processes triggered by the course seem tricky as people have different ways of dealing with identity threat, some of which can be counterproductive and even result in more difficulty quitting. More research is needed to examine who can benefit from a one-time course, and who needs more support in order to quit successfully.
... Descriptive statistics for the scores are presented in Table 1. Interpersonal trust [2] Median (interquartile range) 2. 33 ...
... Interestingly, we too, found a significant association between both current smoking and non-voting with lower levels of trust. A possible causal explanation relates to the increasing stigmatization of smokers [33], which, through the close alignment of social and political engagement, could lead to lower voting behavior among smokers. That we also see lower levels of trust among those not participating in religious meetings could be another indication of such social disengagement. ...
Interpersonal trust declined worldwide during the COVID-19 pandemic; strategies are needed to restore it. We surveyed 3,065 quota-sampled German-speaking adults residing in the D-A-CH region. Using multinomial logistic regression models and backward elimination for variable selection, we calculated multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95% CIs) to appraise correlates of interpersonal trust using the Interpersonal Trust Short Scale (KUSIV3). Participants with high levels of interpersonal trust (top KUSIV3 tertile (T3)) tended to be older, male, residents of Switzerland, university degree holders, and workers with higher income and work satisfaction (all Pdiff<0.01) compared to those in the lowest KUSIV3 tertile (T1). Optimism was most strongly associated with high interpersonal trust (ORT3vsT1 = 5.75, 95%CI = 4.33–7.64). Also significantly associated with high interpersonal trust were: Having voted in the last national election (for the opposition, OR = 1.39, 95%CI = 1.02–1.89 or the governing party, OR = 1.61, 95%CI = 1.23–2.11) versus non-voters; perspective taking (ORT3vsT1 = 1.46, 95%CI = 1.11–1.91); being more extraverted (ORT3vsT1 = 1.99, 95%CI = 1.53–2.59) and more agreeable (ORT3vsT1 = 1.95, 95% CI = 1.46–2.61); and scoring higher on complexity thinking (ORT3vsT1 = 1.32, 95%CI = 1.01–1.72). Participants scoring significantly lower for interpersonal trust did not regularly participate in religious meetings (OR = 0.61, 95%CI = 0.44–0.84, versus participation at least monthly); were more conscientious (ORT3vsT1 = 0.68, 95%CI = 0.51–0.91) or current smokers (OR = 0.68; 95%CI = 0.53–0.87, versus never smoking); had sleep problems >5 times a week (OR = 0.48; 95%CI = 0.36–0.66, versus none); and scored high on conspiracy belief (ORT3vsT1 = 0.53; 95%CI = 0.41–0.69). Results differed minimally by gender and country. These findings may be helpful in devising targeted strategies to strengthen interpersonal trust and social engagement in European societies, especially during times of crises.
... Smoking is stigmatized in many parts of the world, in part deliberately by tobacco control policies aimed at "denormalizing" smoking (Graham, 2012;Stuber et al., 2008). Some smokers feel themselves increasingly labeled as "inconsiderate, sneaky, foolish, irresponsible, … and low class" (Stuber et al., 2009). Such labeling of smokers and the associated stigma are linked empirically to smokers' withdrawal from nonsmokers (Stuber et al., 2009), and policies such as designated smoking areas may reinforce association with the subculture of other smokers. ...
... Some smokers feel themselves increasingly labeled as "inconsiderate, sneaky, foolish, irresponsible, … and low class" (Stuber et al., 2009). Such labeling of smokers and the associated stigma are linked empirically to smokers' withdrawal from nonsmokers (Stuber et al., 2009), and policies such as designated smoking areas may reinforce association with the subculture of other smokers. But the very creation of a subculture stigmatized as selfish, irresponsible, and engaging in a deviant behavior may weaken the social bonds for some of its members-undermining the "conforming influences in their lives" (Lilly et al., 2019)-so that the step to evading taxes becomes a smaller one. ...
Unlike some areas of crime, participation in illicit tobacco markets is not rare and spans most sociodemographic groups. Measurement of the scale of illicit trade in cigarettes usually is for markets with recently increased (or continually increasing) excise taxes. This study examines survey data from adult cigarette smokers in California at a time when prices and taxes had been fairly stable for many years. Even with no recent price shocks in the market, the results indicate that one-third of cigarette packs may lack a valid tax stamp and that between 18 and 25% of smokers avoided taxes by bringing cigarettes into the state from elsewhere in the past month (36% in the past year). Over 10% of packs were purchased for a suspiciously low price and 24–32% of smokers think they might have bought untaxed cigarettes in the past month. Furthermore, 20% think they may have consumed counterfeit cigarettes in the past month. There is a low incidence of illegal sales of single cigarettes. Men, smokers who roll their own cigarettes, e-cigarette users, younger smokers, and those with more income and education are all more likely to engage in at least some of the suspect market behaviors examined. The results show that many smokers from all segments of society participate in the illicit market for cigarettes—wittingly or not—which complicates efforts to reduce illicit trade.
... This is consistent with previous research that shows smoking-related stigma is associated with deleterious health behaviors, including a reluctance to seek cessation assistance and a tendency to conceal smoking behaviors. 35,36 Furthermore, this finding has larger implications on how CHAs conduct these conversations with community members. A recent study has demonstrated that these CHAs-widely regarded as "change agents," may greatly benefit from smoking cessation training sessions that are better tailored to the way they provide health education to communities, and that the tailored training curriculum should highlight the specific needs of more vulnerable populations who are most likely to engage with CHAs. ...
Background
In Alabama only 4% of those eligible have been screened for lung cancer. The ALCASE project focused on navigating eligible individuals to lung cancer screening.
Methods
Trained local staff enrolled screen eligible individuals from seven rural counties and one urban county. Demographics and knowledge of and barriers to lung cancer screening were collected using questionnaires. Education was provided and individuals were navigated to undergo screening. Descriptive statistics for enrolled and screened participants were computed using SAS 9.4. Debriefing interviews were conducted with the ALCASE staff regarding facilitators/barriers to implementing this project and lessons learned. Using NVivo, themes were identified through a combined deductive and inductive process.
Results
In total, 447 people were contacted of which 257 were enrolled. Participants were predominantly African American (86.8%), female (56.8%), and 86.4% had health insurance. Study participants acknowledged the need for more education of lung cancer/screening procedures; help navigating clinics for screening services and having healthcare facilities close to home. The top five barriers to getting screened were transportation, financial issues, emotional concerns, healthcare insurance, and COVID‐19. Of the 257, 106 participants (41%) completed a primary care referral and were screened for lung cancer. Debriefing interviews revealed: (i) Overall impressions of implementing ALCASE were positive. (ii) Barriers in implementing ALCASE were identified predominantly at the physician and institutional level. (iii) Facilitators in implementing ALCASE were identified at multiple levels. (iv) Suggestions on improving lung cancer screening leaned toward mitigating barriers at the institutional and structural level.
Conclusion
Ability to get screened is severely challenged by both personal and structural barriers.
... 47 The stigmatisation of pregnant women who smoke may lead to women hiding their smoking and a Open access hesitancy to engage with professional smoking cessation support. 48 49 We sought women who had experience of smoking in pregnancy but did not seek those who were trying to stop or to cut down smoking at all. Nevertheless, half of the women enrolled in this study were using NRT to cut down their smoking, and over half were not actively engaged with stop smoking services. ...
Objectives
To explore the acceptability and perceived motivations and barriers of using nicotine replacement therapy (NRT) to reduce the number of daily cigarettes smoked in pregnancy, rather than for stopping completely.
Design
Telephone, semi-structured interviews, audio-recorded and transcribed verbatim. Transcripts were analysed using an inductive thematic analysis.
Participants
Eighteen pregnant women in the UK, who were smoking or had recently stopped smoking, were recruited.
Results
Half of interviewees reported having used NRT to reduce smoking during their current pregnancy, and there was overwhelming support for the UK National Health Service to recognise this as a potentially useful way to use these products. The cost and stigma associated with purchasing NRT products when pregnant were seen as barriers to using NRT in this way. The early offer of NRT for reduction along with a tailored, structured approach to support was seen as important.
Conclusions
Using NRT to help women, who are unable to stop smoking, to reduce their smoking may be acceptable to pregnant women. This study found women were already using NRT alongside ad hoc strategies to reduce their smoking. Further research evaluating structured smoking reduction support, alongside concurrent NRT use is needed.
... Peraturan tersebut merupakan salah satu upaya perlawanan terhadap rokok dan penekanan dampak kesehatannya (Voigt, 2010). Kampanye antirokok semakin memperparah stigma dan diskriminasi terhadap para perokok (Stuber et al., 2009). Asketik: Jurnal Agama dan Perubahan Sosial ISSN: 2615-4668 (Online) 2579-7050 (Printer) V0l. 7, No. 2 (2023pp. ...
This article analyzes how young women smokers defend themselves and perpetuate their smoking activity in an environment that rejects it through discursive understanding as the basis for their actions. In addition, this study discusses how women smoke and take into account smoking activity, social aspects, and physical aspects around it. The theoretical approach used is the agency theory of Anthony Giddens which deeply considers the aspects of managed reflexivity. This theory underlines that a continuous flow or stream of acts is inherently constructed by a process of rationalizing actions to underlie the agent's actions through reflexive monitoring. This study uses qualitative methods to obtain in-depth information from primary sources, namely smoking women in Yogyakarta. To support primary data, observation and documentation are used as secondary data sources. This article scrutinizes (1) women as social agents reflect the surrounding norms, smoking ethics, their body's acceptance of smoking, and their health risks, (2) women smokers rationalization their actions with a practical and discursive basis include the history of smoking women, gender equality, discourse on pharmaceutical interests, and culturally expressed self-freedom, and (3) smoking women are passive agents, namely agents who act within the limits of the structure but have power over themselves. to express themselves.
... Taken together, the present findings indicate that the perceived public stigma of smokers in Norway is most common among highstatus groups, and those who emphasise status (and emancipation) as values. As such, our findings are congruent with the Stuber group's findings from New York City (Stuber et al., 2008(Stuber et al., , 2009. ...
Smoker stigma is a likely unintended consequence of tobacco polices aiming to denormalise smoking. Little is known about the dissemination of stigmatising attitudes toward smokers at the population level, including their associations with personal values. Applying a theoretical approach that conceptualises stigma as a cultural (moral and intersubjective) issue, we analyse the spread of perceived public stigma of smokers in Norway and factors predicting agreement with such a perception. Using merged data from the biennial national survey Norwegian Monitor 2011 and 2013 (N = 7,792), we tested whether the tendency to agree with a perceived public stigma of smokers differs by four indexes of value opposites (‘puritanism/emancipation,’ ‘conformity/individuality,’ ‘tolerance/intolerance,’ ‘status/anti-status’), controlling for smoking status, SES, and demographics. Descriptive statistics and block-wise logistic regression models were applied. In the total sample, 59.1% agree with the statement that ‘most people think less of a person who smokes.’ Two of the four indexes of value opposites tested were associated with tendencies to agree with the perceived public stigma of smokers (‘puritanism/emancipation’ and ‘status/anti-status’). Smokers with current plans to quit expressed the highest perceived public stigma, while ex-smokers expressed a higher perceived public stigma than never-smokers. Women, young people and respondents with high SES agree with a public stigma of smokers more than men, older people and respondents with low SES do. The perceived public stigma of smokers is high in Norway and varies to some extent with personal values, but also with socio-demographics and especially smoking status.
... With smokers, the conversation about the difficulty in quitting smoking highlights a great potential opportunity to help find support for quitting. Research suggests that smokers often conceal their smoking status and socially withdraw from nonsmokers (Stuber, Galea, & Link, 2009). Instead, smokers may identify more with other smokers (Falomir & Invernizzi, 1999). ...
... Perceived smoking-related discrimination may have been a barrier to supporting SF2025 goal measures. 23 We measured this through agreement on a five-point scale (from strongly agree to strongly disagree) to the statements: "smokers are second class citizens"; "people look down on you when they know you are a smoker"; and "you feel ashamed when people see you smoking" as having been exposed to smokingrelated discrimination. We then created a dichotomous derived variable for reported experiences of smoking-related discrimination. ...
Aim:
The recently passed Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act has the potential to profoundly reduce smoking prevalence and related health inequities experienced among Māori. This study examined support for, and potential impacts of, key measures included within the legislation.
Method:
Data came from Wave 1 (2017-2019) of the Te Ara Auahi Kore longitudinal study, which was conducted in partnership with five primary health organisations serving Māori communities. Participants were 701 Māori who smoked. Analysis included both descriptive analysis and logistic regression.
Results:
More Māori participants supported than did not support the Smokefree 2025 (SF2025) goal of reducing smoking prevalence to below 5%, and the key associated measures. Support was greatest for mandating very low nicotine cigarettes (VLNCs). Participants also believed VLNCs would prompt high rates of quitting. Participants who had made more quit attempts or reported less control over their life were more likely to support VLNCs.
Conclusion:
There was support for the SF2025 goal and for key measures that could achieve it. In particular, VLNCs may have significant potential to reduce smoking prevalence among Māori. As part of developing and implementing these measures it will be important to engage with Māori who smoke and their communities.
... This includes context-specific factors and dynamics that may impact public health behavioural change interventions with health professionals across cultures [29,30]. One particular social issue that warrants consideration is the widely accepted unintended consequence associated with tobacco control strategies, the stigmatisation of smokers [31,32]. Two systematic reviews propose that the stigmatisation of smokers may in and of itself undermine cessation efforts among residual smokers in the general population [33,34]. ...
Background:
Offering cessation support to health professionals who smoke to ensure optimal implementation of cessation support for patients is a key recommendation of the WHO Framework Convention on Tobacco Control Article 14 guidelines. However, direct efforts to support this population to quit are limited. Although numerous articles on the topic of tobacco use among health professionals have been published, the factors associated with their own cessation have not been systematically synthesised.
Objective:
We sought to synthesise existing literature on the predictors and processes informing attitudes and beliefs of smoking health professionals' own cessation.
Methods:
A five-step methodological framework for scoping reviews was followed. We conducted a systematic search of EMBASE, PubMed, Web of Science, and PsycINFO databases, as well as Google Scholar for relevant articles. Titles, abstracts, and full texts were screened against predefined criteria: research published between 1990 and 2021, in English-language peer-reviewed journals; participants included doctors, nurses, medical, and student nurses who smoke.
Results:
The initial search yielded 120, 883 articles, with 27 selected for synthesis. Prevalence estimates and predictors of smoking behaviour have remained the primary focus of smoking health professional research. Few studies explicitly examined the relevant predictors of quit attempts and quit attempt success. There is evidence that age and work environment factors predict quit attempt success in some health professional groups. There is also some evidence of tobacco smoking stigma experiences among nurses and nursing students who smoke.
Conclusion:
Although cessation support is desperately needed for health professionals who smoke, the evidence for factors predicting quit success remains limited. To better guide future research, first, more theoretical work is required to identify the relevant predictors. Second, these should be tested using prospective research designs that take a multi-focal perspective to clarify the targets for change.
... However, not all findings showed a positive relationship between a negative social environment toward smoking and smoking cessation. Some studies found that stigmatized smoker images increased smoking as a form of psychological reactance [35] or showed no influence on smoking reduction [36]. Further studies need to examine how the changed smoking stigma after COVID-19 and the discrepancy between smokers and non-smokers could be used to induce smoking cessation. ...
Objectives:
This study aimed to analyze the changes in smoking stigmatization in relation to an individual's smoking status after the COVID-19 outbreak.
Study design:
A 2 (before vs. after COVID-19) X 2 (smoking status: smoker vs. non-smoker) factorial design was developed.
Methods:
Two national surveys were conducted, one each before (between January 7th and 15th, 2020) and after (between January 26th and February 18th, 2021) the COVID-19 outbreak in South Korea. A total of 7296 representative adult responses were finalized. Respondents were categorized into two groups: non-smokers and smokers. Smoking stigma was measured in two ways: social and personal.
Results:
In general, smoking stigmatization intensified after the COVID-19 outbreak. However, there was a discrepancy in responses based on smoking status-non-smokers exhibited a heightened negative stigma toward smokers, whereas smokers had generous perspectives about themselves.
Conclusions:
The health-oriented environment generated by the response to COVID-19 is leading to increased stigmatization of smokers who pose a risk to public health. However, the discrepancy between smokers and non-smokers shows that social efforts are required to alter smokers' generous views about themselves and to persuade them to cease smoking.
... Studies on the effects of stigmatization of people with AIDS show that the feeling of stigmatization due to one's health status is associated with anxiety, depression, distrust, and the disruption of normal social relationships (Crandall & Coleman, 1992;Herek, 1999). Similar findings of stigmatization and its harmful effects have been reported for smokers and obese people (Goldstein, 1991;Hilbert et al., 2008;Myers & Rosen, 1999;Peretti-Watel et al., 2014;Stuber et al., 2009). ...
Social media data hold considerable potential for predicting health-related conditions. Recent studies suggest that machine-learning models may accurately predict depression and other mental health-related conditions based on Instagram photos and Tweets. In this article, it is argued that individuals should have a sui generis right not to be subjected to AI profiling based on publicly available data without their explicit informed consent. The article (1) develops three basic arguments for a right to protection of personal data trading on the notions of social control and stigmatization, (2) argues that a number of features of AI profiling make individuals more exposed to social control and stigmatization than other types of data processing (the exceptionalism of AI profiling), (3) considers a series of other reasons for and against protecting individuals against AI profiling based on publicly available data, and finally (4) argues that the EU General Data Protection Regulation does not ensure that individuals have a right not to be AI profiled based on publicly available data.
... It is possible, however, that the presence of a home smoking ban could influence people's level of social support. Some smokers, for example, experience stigma due to smoking, which may affect their relationships with nonsmokers (Stuber et al., 2009). Likewise, the desire to avoid stigma (mainly by having a home that does not smell of cigarette smoke) can motivate people to create or maintain a smoke-free home (Passey et al., 2016). ...
Home smoking bans reduce exposure to second-hand smoke. Understanding how psychosocial factors are related to having a home smoking ban may lead to better interventions for populations less likely to have home smoking bans, including low-income smokers. In this study, we used baseline data from 1,944 participants in a randomized trial of low-income smokers in Missouri to explore psychosocial correlates of a total home smoking ban. Using logistic regression, we examined associations between psychosocial variables (social support, unmet social needs [e.g., food, housing], perceived stress, and depressive symptoms) and a total home smoking ban. 72% of participants were female, and 58% were Black/African American; 26% reported a home smoking ban. In unadjusted and adjusted models, greater social support was associated with greater likelihood of a home smoking ban. Stress was negatively associated with a ban in adjusted models only. The fact that most participants did not have a home smoking ban highlights the need for further intervention in this population. Results suggest links between social support and having a home smoking ban, although effect sizes were small. Smoke-free home interventions that increase social connectedness or leverage existing support may be especially effective. Tobacco control planners may also consider partnering with agencies addressing social isolation.
... Contrary to this study, other studies related to MTM have shown practice for a change and changes in the social environment are associated with other health behaviors such as small portion size, physical activities, and plain water con-sumption [24][25][26]. It may be due to unwillingness to i) monitor their smoking habit by maintaining dairy and ii) social stigma related to smoking habits [31]. It is also further supported by a median score (Md = 3) which is very low. ...
Introduction: Smoking and use of other tobacco products are a global public health threat. The objective of the study was to predict the initiation and sustenance of smoking cessation (SC) by applying the multi-theory model (MTM) of health behavior change. Methods: In a cross-sectional study, the face-to-face interview was conducted by visiting different public places and coffee shops in Kathmandu Metropolitan, Nepal. A 30-item valid and reliable MTM-based survey instrument was administered to the participants who smoked cigarettes. Stepwise multiple regressions were conducted to explain SC behavior. The entire value of the Cronbach alpha coefficient (α) of the subscales and the scale was 0.91 which is excellent internal consistency. Results: A total of 132 participants completed the study (93.6%). The median age of participants was 35.53 years and 75% of them were males. The median number of cigarettes smoked per day was 7. Behavioral confidence (β = 0.06, P = 0.02) and changes in the physical environment (β = 0.11, P = 0.01) were significant predictors for the initiation of SC. Next, emotional transformation (β = 0.25, P < 0.001) was a significant predictor for sustenance for SC. Conclusion: MTM has the usefulness to assess both the initiation and sustenance behavior of SC. Potential solutions using MTM constructs should be developed in future interventions to change behavior of SC.
... HIV-related stigma increases the odds of smoking among PLWH (Gamarel et al., 2020;Zhang et al., 2018). Although tobacco is a legal substance, smoking behavior is increasingly stigmatizing as people become aware of the detrimental effects of smoking and exposure to secondhand smoke (Brown-Johnson & Popova, 2016;Stuber et al., 2009). A systematic review of studies on tobacco smoking indicated that awareness of smoking stigma is virtually universal (Evans-Polce et al., 2015). ...
This study examined the intersectionality of HIV-related stigma, tobacco smoking stigma, and mental health among women living with HIV who were daily smokers. This secondary analysis used baseline data from 2 pilot smoking cessation studies. Participants received either an HIV-tailored or an attention-control intervention focused on smoking cessation as an outcome. There were significant positive relationships between HIV-related stigma and depressive and anxiety symptoms. In contrast, tobacco smoking stigma had no significant relationship with either of the symptoms when HIV-related stigma was controlled. However, there was a significant interaction effect (β = 1.37, p = .02) of tobacco smoking stigma with internalized HIV-related stigma on anxiety symptoms. Tobacco smoking stigma worsened anxiety symptoms for women who had high internalized HIV-related stigma. Health care providers should understand the effect of HIV-related stigma on mental health and address the intersectionality of HIV-related stigma with other socially disapproved behaviors, such as tobacco smoking.
... Based on our questionnaire, only one of the smokers said he only smokes outside, which indicates some smokers may smoke immediately outside the home. In addition, due to social desirability, people regularly report not smoking indoors when they actually do [27]. Although houses were ventilated by windows or doors being left open, it is not uncommon to observe wall cracks in Native American houses, which makes them permeable to PM incursions from outdoors. ...
Background
Indoor air pollution is associated with adverse health effects; however, few studies exist studying indoor air pollution on the Navajo Nation in the southwest U.S., a community with high rates of respiratory disease.
Methods
Indoor PM2.5 concentration was evaluated in 26 homes on the Navajo Nation using real-time PM2.5 monitors. Household risk factors and daily activities were evaluated with three metrics of indoor PM2.5: time-weighted average (TWA), 90th percentile of concentration, and daily minutes exceeding 100 μg/m³. A questionnaire and recall sheet were used to record baseline household characteristics and daily activities.
Results
The median TWA, 90th percentile, and daily minutes exceeding 100 μg/m³ were 7.9 μg/m³, 14.0 μg/m³, and 17 min, respectively. TWAs tended to be higher in autumn and in houses that used fuel the previous day. Other characteristics associated with elevated PM exposure in all metrics included overcrowded houses, nonmobile houses, and houses with current smokers, pets, and longer cooking time.
Conclusions
Some residents of the Navajo Nation have higher risk of exposure to indoor air pollution by Environmental Protection Agency (EPA) standards. Efforts to identify the causes and associations with adverse health effects are needed to ensure that exposure to risks and possible health impacts are mitigated.
... When smokers are asked to describe their stigma experience, they have little difficulty naming a range of situations including the momentary (people coughing hysterically to a brief exposure to smoke), the impractical (having to stand outside to smoke at work or restaurants), the economic (paying more for health insurance), and the hurtful (being avoided or seen as disgusting; Brandt, 2007;Helweg-Larsen et al., 2010). Thus, smokers experience both interpersonal and structural forms of discrimination that support their exclusion from various parts of social life (Stuber et al., 2008(Stuber et al., , 2009. Stigmatized individuals, such as smokers, are perceived to have a characteristic or attribute that is devalued in a particular social situation (Crocker et al., 1998) and as a result, they are often stressed by the experience or anticipation of mistreatment; mistreatment which includes being ignored and excluded (Williams, 2007). ...
Research on the effects of stigmatizing on smokers shows that it is stressful to be reminded of one’s devalued status and stigmatization might help or hinder quitting intentions. In this study, we asked smokers (N = 277) to play an online ball-tossing Cyberball game, ostensibly with nonsmoking strangers. Participants were randomly assigned to an ostracism (included or excluded) and concealment (smoking status concealed or revealed) manipulation. We found that exclusion led smokers (directly or via threat appraisals) to be more stressed, cognitively depleted, rejection sensitive, have fewer positive cognitions, see themselves at greater health risk, feel more internalized stigma, and be more interested in quitting, with stronger effects when their smoking status was revealed instead of concealed. These results suggest that concealment is imperfect in protecting against stigma and that exclusion (although stressful and cognitively taxing) can lead to cognitions, attitudes, and intentions helping smokers quit and thus leave their devalued identity. The results do not imply that one ought to stigmatize; stigmatizing smokers might be unethical or create barriers to health-seeking behaviors which could counteract structural efforts to help smokers quit. Future research should examine the role of self-affirmation to increase the effectiveness of health messages perceived as stigmatizing or identity threatening.
... In response to the pressing call for empirical research to investigate whether the de-normalization strategy unwittingly contributes to enlarging the gap in smoking prevalence across social strata, our study provides clear evidence that the strategy does lower the cessation intention of lowincome smokers with less self-confidence about quitting smoking. Considering that smoking has become an increasingly denigrated activity in society, de-normalizing tobacco use has been taken for granted in campaign message design without much consideration of whether smokers buy into such social unacceptability (Stuber, Galea, & Link, 2009). For this reason, it is imperative to know that the strategy may produce a boomerang effect among certain smoking populations. ...
Based on the Social Cognitive Theory (SCT), this study used a survey to examine personal, behavioral, and environmental factors affecting young adults’ stigmatic views toward people misusing prescription opioid drugs (POD). Results indicated that stigmatic perception was negatively related to exposure to news coverage while positively associated with anti-opioid abuse messages. People with more stigmatic views toward POD misusers assigned more blame to these misusers than to pharmaceutical companies. POD misuse was negatively related to stigmatic views; the correlation coefficient was greater among people with high self-efficacy compared to those with low self-efficacy. The results provide an interesting glimpse and add to the overall knowledge of POD-related stigmatic views among young adults. It provides initial yet compelling evidence for the potential influence of various types of media content, self-efficacy, and POD misuse behavior on the stigmatic view. The findings may also help policymakers and the public to counter the opioid crisis in America more effectively.
... The informants reflected on the effects that these policies had on them, suggesting that they could be beneficial. At the same time, they could stigmatize tobacco use [29] and create feelings of shame and guilt among tobacco users [30,31], as reported in this study and elsewhere. This could be reinforced by the informants' view of tobacco use as the individual's responsibility, a view that has also been reported in previous research [32]. ...
Background
Tobacco Cessation on Prescription (TCP) is a new intervention that is being evaluated in socioeconomically disadvantaged areas in Swedish primary health care (PHC). Patients’ perceptions of TCP are important to understand as this may have implications for the acceptability and adherence to treatment and explain cessation outcomes. Patients’ general experiences of tobacco cessation are also important to explore to improve cessation support in this setting.
Aim
To explore experiences of tobacco cessation and TCP among patients in Swedish PHC focusing on socioeconomically disadvantaged areas.
Methods
Inductive content analysis of transcripts from eight semi-structured interviews with patients recruited from the intervention group in a randomized controlled trial evaluating the effectiveness of TCP in socioeconomically disadvantaged areas in PHC in Stockholm.
Results
Two themes were identified: needing individualized support to quit, taking differences in patients’ experiences of tobacco use and cessation into account, acknowledging individual factors such as impact of health and wellbeing on tobacco use and differing attitudes towards tobacco and cessation and needing a supportive environment to facilitate tobacco cessation, taking contextual factors like professional support from the health care system, the importance of the social environment and supportive societal structures into account. Regarding TCP, the prescription form was perceived as useful for providers but did not appear to have a direct impact on tobacco cessation from the informants’ perspective. However, individualized counseling from a tobacco cessation specialist, an empathetic approach in the treatment and long-term follow-up was considered important.
Conclusion
A holistic approach may be needed in cessation treatment, combined with interventions outside the health care system, to facilitate tobacco cessation among patients in socioeconomically disadvantaged areas in Swedish PHC. The TCP prescription form may be helpful for PHC providers but counseling and follow-up appear to be the most important components of TCP for patients in this setting.
... For example, while surely there should not be genuine intent to negatively label, or categorically stereotype, drug users as 'bad persons', there are many behaviorsin the social realities of daily life, health, or substance usethat are widely recognized and agreed as factually unhealthy and undesirable, and therefore feature legitimate reason (e.g., for the benefit of interventions) to be negatively labelled. For example, 'drinking and driving', smoking in front of children, sharing injection paraphernalia, or stealing are generally agreed-upon risky or harmful behaviors which are for education or prevention messaging or deterrence purposesnegatively labelled and so conveyed for arguably good reason [24,25]. It cannot be in anyone's (and especially not prominent health leaders') real interest to suggest correction of these behaviors to positive, or even neutral status or messaging in the interest of all-encomassing 'stigma reduction'. ...
Canada has been home to a longstanding public health crisis related to opioids, including an extensive mortality and morbidity toll in the face of substantive intervention gaps. Recently (2019), two extensive reports from preeminent federal authorities – the Chief Public Health Officer and the Mental Health Commission of Canada – have been tabled with detailed, core focus on the phenomenon of ‘stigma’ and its impacts on substance/opioid use and harms. The reports present extensive descriptions of the nature and effects, as well as a multitude of prescriptions for remedial measures and actions to “stop the cycle of stigma”. Closer reading of the documents, however, suggests substantial conceptual and empirical limitations in the characterization of the – multi-faceted and challenging – nature and workings of ‘stigma’ as a socio-political, structural or individual process or force, specifically as it applies to and negatively affects substance use and related outcomes, primarily the wellbeing of substance users. Concretely, it is unclear how the remedial actions proposed will materially alleviate stigma process and impacts, especially given apparent gaps in the issues examined, including essential strategies – for example, reform of drug user criminalization as a fundamental element and driver of structural stigma - for action that directly relate to the jurisdictions and privileged mandates of the report sources themselves as health and policy leaders. The commentary provides some concrete while subjective notes and observations on the dynamics of stigma as applies to and framed for substance/opioid use, as well as strategies and measures necessary to both tangibly address the material health and wellbeing of substance users, and related forces of stigma, in the distinct context of the opioid crisis in Canada.
... Studies on the effects of stigmatization of people with AIDS show that the feeling of being stigmatized is associated with anxiety, depression and distrust, and the disruption of normal social relationships [60,61]. There is evidence of stigmatization and its harmful effects for a wide variety of groups of people, including smokers and obese people [62][63][64][65][66]. ...
Background:
Health data holds great potential for improved treatments. Big data research and machine learning models have been shown to hold great promise for improved diagnostics and treatment planning. The potential is tied, however, to the availability of personal health data. In recent years, it has been argued that data from health records should be available for health research, and that individuals have a duty to make the data available for such research. A central point of debate is whether such secondary use of health data requires informed consent.
Main body:
In response to recent writings this paper argues that a requirement of informed consent for health record research must be upheld. It does so by exploring different contrasting notions of the duty of easy rescue and arguing that none of them entail a perfect duty to participate in health record research. In part because the costs of participation cannot be limited to 1) the threat of privacy breaches, but includes 2) the risk of reduced trust and 3) suboptimal treatment, 4) stigmatization and 5) medicalisation, 6) further stratification of solidarity and 7) increased inequality in access to treatment and medicine. And finally, it defends the requirement of informed consent by arguing that the mere possibility of consent bias provides a rather weak reason for making research participation mandatory, and that there are strong, independent reasons for making.
Conclusion:
Arguments from the duty of easy rescue in combination with claims about little risk of harm and potential consent bias fail to establish not only a perfect duty to participate in health record research, but also that participation in such research should be mandatory. On the contrary, an analysis of these arguments indicates that the duty to participate in research is most adequately construed as an imperfect duty, and reveals a number of strong reasons for insisting that participation in health records research is based on informed consent.
... Under the situation in which individuals realize other people can impose negative, biased judgment on themselves, they tend to engage in coping strategies (Markowitz, 1998). Stuber, Galea and Link (2009) have argued the positive role of self-stigma that it can contribute to smokers' intentions to quit smoking in order to avoid social exclusion and conform to social norms. On a related note of the role of self-stigma in increasing health-promoting behaviors, Smith et al. (2007) have provided the empirical finding that stigma motivated intentions to support people with HIV. ...
... Kim, 2018). Our work here suggests a novel opportunity to address the problem much in the same way that stigma was leveraged against smoking to decrease smoking rates at large (Bayer & Bachynski, 2013;Bell, Salmon, Bowers, Bell, & McCullough, 2010;Evans-Polce, Castaldelli-Maia, Schomerus, & Evans-Lacko, 2015;Riley, Ulrich, Hamann, & Ostroff, 2017;Stuber, Galea, & Link, 2009). Since we proposed that stigma can be reduced by eliciting affective reactions and increasing perceived similarity, having audiences become narratively engaged with a story that does the same for victims of TWD crashes or inversely decreases similarity or elicits negative affective reactions may each increase perceptions of stigma. ...
Two exploratory studies demonstrate, for the first time, that narrative persuasion can diminish the stigma attached to social groups featured in journalistic narratives. Study 1 shows narrative format improves stigma toward Syrian refugees indirectly through narrative engagement, perceived similarity, and meaningful affect. Decreases in stigma also improved attitudes toward refugees. Study 2 replicates these findings against a separate participant pool, an additional story topic, and compares changes in engagement, stigma, and attitude to a non-narrative fact sheet and a control condition. A preregistered third study seeks to validate the finding that narratives can elicit destigmatization and disentangle the roles of story exemplars from story structure.
... Facebook also allows targeting ads at specific users, based on their interests and activities. However, as smoking is not a totally acceptable behavior 35,36 , people may want to hide their smoking status 37,38 in social networks. In this sense, recruiting based on Facebook interests or likes will fail to capture many populations 39 . ...
Gain- and loss-framed messages about smoking behavior have commonly been used to promote cessation. However, there are still no clear conclusions as to what kind of message is more effective for motivating smokers to quit. This study compared the effectiveness of loss- and gain-framed messages in the online recruitment of smokers via Facebook Advertising. Loss- and gain-framed messages about smoking were created and released as Facebook ads. Users who clicked on the ads were automatically redirected to the “Live Without Tobacco” intervention (http://www.vivasemtabaco.com.br). The amount spent on the ads was BRL 647.64. Data were collected from the Facebook Ads platform and from a relational database. Analyses were performed on the 6,350 users who clicked on one of the ads and 1,731 who were successfully redirected to the intervention. Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527. The former received 2,688 clicks, while the latter received 3,662. The cost of the click was BRL 0.12 per gain-framed ad and BRL 0.09 per loss-framed ad. Loss-framed ads reached more users, got more clicks (and website accesses), and led to more accounts and quit plans being created. Loss-framed messages about smoking appear to be more cost-effective for both initial recruitment and intervention engagement. Facebook has proven to be a good outreach and recruitment tool and can be a solution for the difficulty in reaching smokers for cessation interventions.
... More recently, interest has increased in beliefs that relate to the benefits and risks of smoking for the chance to participate in society, such as opportunities for employment, starting a family, renting a house, or getting health insurance. These, which we refer to here as "societal beliefs," have not yet been linked to smoking initiation, but were shown to be an adequate proxy measure of a smokers experience of discrimination (Stuber et al., 2008(Stuber et al., , 2009). SFSP may more strongly influence some types of beliefs than others, though to-date no studies exist that have addressed this question. ...
Background
Smoke-free school policies (SFSPs) may influence adolescents’ smoking through the development of anti-smoking beliefs. We assessed which types of anti-smoking beliefs (health, social and societal) are associated with SFSPs and whether these associations were different for adolescents in smoking permissive versus prohibitive families.
Methods
Survey data was collected in 2016–2017 from 10,980 adolescents between 14–16 years old and 315 staff in 55 schools from seven European cities. We separately measured adolescent-perceived SFSP and staff-reported SFSP at the school-level. Associations between SFSP and anti-smoking health, social and societal beliefs were studied using multi-level logistic regression, adjusting for demographics and school-level smoking prevalence. We tested for interactions between family norms and SFSP, and estimated associations for adolescents in permissive and prohibitive families, respectively.
Results
Adolescent-perceived SFSP was not significantly associated with anti-smoking health (OR:1.08, 95%CI:0.94–1.25), social (OR:0.89, 95%CI:0.75–1.04) and societal beliefs (OR:1.15, 95%CI:0.99–1.33). Staff-reported SFSP were associated with anti-smoking health beliefs (OR:1.12, 95%CI:1.01–1.24), but not with social (OR:0.94, 95%CI:0.83–1.07) or societal beliefs (OR:1.02, 95%CI:0.90–1.14). Most results were comparable between adolescents in smoking prohibitive and permissive families. However, in smoking prohibitive families, adolescent-perceived SFSP were associated with societal beliefs (OR:1.24, 95%CI:1.06–1.46), but not in permissive families (OR:1.06, 95%CI:0.90–1.25). Also, in smoking permissive families, staff-reported SFSP were associated with more pro-smoking social beliefs (OR:0.83, 95%CI:0.72-0.96), but not in prohibitive families (OR:1.05, 95%CI:0.92-1.16).
Conclusions
We found evidence that SFSP are associated with some anti-smoking beliefs, but more so among adolescents from smoking prohibitive families than from permissive families.
... In recent years, tobacco control advocates and public policy makers in some countries began to pursue denormalisation as a discrete policy goal (Feldman & Bayer, 2011), in addition to advertising bans, public smoking restrictions and increased tobacco excise tax. Debate among public health advocates and tobacco control researchers about the ethics associated with the ongoing and targeted use of denormalisation has followed (Bayer, 2010;Bell, Salmon, Bowers, Bell, & McCullough, 2010;Stuber, Galea, & Link, 2008, 2009). Despite the extraordinary success of public health campaigns in dramatically reducing smoking prevalence in industrialised nations such as New Zealand, Canada, the United States, the United Kingdom and Australia, a strong social gradient of tobacco smoking, morbidity and mortality has been reported (Feldman & Bayer, 2011). ...
In remote Aboriginal communities in East Arnhem Land, Northern Territory of Australia, the Yolŋu people, traditional owners of this remote and isolated region, have a long tradition of ŋarali’ [tobacco] use, which is commemorated within funeral ceremony, as manikay [songlines] and buŋgul [dancing]. Today, smoking is very prevalent and a highly normalised social activity among Yolŋu. There are concerns that tobacco control activities aiming to denormalise smoking may lead to stigma in already disadvantaged communities with high smoking prevalence. Interviews were conducted from August 2014 until December 2015 to ascertain whether smokers may have experienced smoking-related stigma through their interactions and engagement with health services and regional tobacco control activities including denormalisation strategy. Informants described their experiences, observations and perceptions of smokefree environments, television and media advertising, and smoking cessation support. We found that while tobacco control denormalisation is not leading to stigma in these communities, some clinical consultations and interactions may have led to feelings of smoking-related shame among Yolŋu health workers who smoked. However, we found that caring, trusting relationships and having the right people communicating the right messages respectfully enabled raising the issue of smoking in clinical consultations without causing shame.
... However, educational attainment was negatively correlated with stigma. In prior studies, the association between educational attainment and stigma has been mixed, (Chiao et al., 2009;Stuber et al., 2009;Tsai and Venkataramani, 2015;Wolfe et al., 2008), while knowledge specifically about the disease condition has been associated with lower levels of stigma (Bogart et al., 2008;Girma et al., 2014;Mugoya and Ernst, 2014;Yang et al., 2006;Youssef et al., 2018). We further found that those who identified with Protestant or Catholic faith had higher levels of HIV-related stigma compared to those who identified as neither. ...
Rationale:
HIV-related stigma profoundly affects the physical and social wellbeing of people living with HIV, as well as the community's engagement with testing, treatment, and prevention. Based on theories of stigma elaborating how it arises from the relationships between the stigmatized and the stigmatizer as well as within the general community, we hypothesized that social networks can shape HIV-related stigma.
Objective:
To estimate social network correlates of HIV-related stigma.
Methods:
During 2011-2012, we collected complete social network data from a community of 1669 adults ("egos") in Mbarara, Uganda using six culturally-adapted name generators to elicit different types of social ties ("alters"). We measured HIV-related stigma using the 9-item AIDS-Related Stigma Scale. HIV serostatus was based on self-report. We fitted linear regression models that account for network autocorrelation to estimate the association between egos' HIV-related stigma, alters' HIV-related stigma and alters' self-reported HIV serostatus, while adjusting for egos' HIV serostatus, network centrality, village size, perceived HIV prevalence, and sociodemographic characteristics.
Results:
The average AIDS-Related Stigma Score was 0.79 (Standard Deviation = 0.50). In the population 116 (7%) egos reported being HIV-positive, and 757 (46%) reported an HIV-positive alter. In the multivariable model, we found that egos' own HIV-related stigma was positively correlated with their alters' average stigma score (b=0.53; 95% confidence interval [CI] 0.42-0.63) and negatively correlated with having one or more HIV-positive alters (b=-0.05; 95% CI -0.10 to -0.003).
Conclusion:
Stigma-reduction interventions should be targeted not only at the level of the individual but also at the level of the network. Directed and meaningful contact with people living with HIV may also reduce HIV-related stigma.
... 22 Stigmatizing smokers may have positive results by increasing the level of social unacceptability and the acceptability of tobacco-free policy enforcement. 21,23 This may be critical for young adults, for whom the initiation of smoking may not fully take hold for several years. 24 A nationally representative survey of 4-year colleges and universities in the United States showed broad support (over 75%) for tobacco-free campus policies regardless of smoking status. ...
Objective: Nearly half of U.S. colleges/universities have implemented tobacco-free campus policies. This study analyzed knowledge, attitudes, and practices associated with the tobacco-free policy at a large public university. It is important to study public university tobacco policies to determine the most efficient and cost-effective way to reduce tobacco related disease due to tobacco use and exposure. Methods: This study used a cross-sectional, campus-wide electronic survey distributed in November 2016. The primary outcomes of interest included 1) correct knowledge of the tobacco-free policy, 2) community member willingness to approach observed violation of the policy, and 3) a positive opinion of the policy’s effectiveness. Descriptive statistics and logistic regression were used to examine the impact of demographic factors on the outcomes. Results: After analysis, the team found that 23% of university faculty, staff, and students had incorrect knowledge about the campus tobacco-free policy. Almost 70% of the university community reported not having approached a smoking violator. Males were significantly less likely to understand the tobacco-free policy in full, approach a violator, or have a positive opinion about its effectiveness. Staff had better knowledge of the policy, a higher likelihood of approaching a violator, and a better opinion about the policy’s effectiveness compared to graduate and undergraduate students. Conclusions: Interventions are needed to increase awareness and confidence regarding implementation and enforcement of the tobacco-free policy on campus, particularly among faculty and students. This paper expands on the currently increasing knowledge of tobacco-free policy enforcement and benefits. KEYWORDS: Campus; Tobacco Regulation; Tobacco; Secondhand Smoke; Cross-Sectional Survey
Introduction
African Americans/Blacks (AAB) are at increased risk for morbidity and mortality from smoking-related diseases including lung cancer (LC). Smoking stigma is believed to be a primary barrier to health care-seeking for people who smoke. Previous studies illustrate that perceptions of smoking vary across populations. However, little is known about the prevalence of smoking stigmas among AAB. The purpose of this study was to increase understanding of the perception of cigarette smoking by AAB.
Aims and Methods
We conducted free-listing interviews in which individuals listed all-thoughts and feelings regarding smoking and health-related questions with a convenience sample of eligible AAB adults (n = 58) in the Philadelphia region. Additionally, we collected participant self-reported demographic data. Data were cleaned and the salience of each term was computed using Anthropac. Graphical methods were then used to determine salient responses across groups stratified by gender, age, education, and smoking status.
Results
The sample had a median age of 51 years and was 67.2% female. Most participants had completed college (58.6%) and had never smoked (74.1%). Regarding their perceptions of people who smoke cigarettes, results showed that “smelly,” “health hazard,” and “judgment” were the most salient terms among all-participants. Overall, “smelly” and “unhealthy” were salient for both males and females. However, “dental,” “dirty,” “addictive,” and “habit” were also salient among males. Phrases such as “unhealthy” and “addictive” were primarily salient for older participants (>51 years) versus “smelly” for younger participants. The term “smelly” was salient among all-education levels. However, “unhealthy” was also salient among those with less than a 4-year college degree. Moreover, the terms “smelly” and “annoying” were most common among people who smoke as opposed to “health hazard” among people who don’t smoke.
Conclusions
We observed that the most stigmatizing language was primarily associated with perceptions of negative social interactions, social judgment, and health-related concerns. Future studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and LC screening protocols.
Implications
Little is known about the prevalence of smoking stigmas among AAB. This study explores the AAB perspective of cigarette smoking and related stigmas. Among AAB, smoking is represented by stigmatizing language across gender, age groups, and smoking history. It is primarily associated with negative social interactions, social judgement, and health-related concerns indicating that smoking stigma is a concern for AAB individuals who smoke. Further research is warranted.
La prévalence et la sévérité du tabagisme sont particulièrement élevées dans les populations en situation de précarité et font du tabagisme un déterminant essentiel des inégalités sociales de santé, du fait de son impact particulièrement catastrophique sur la santé de ces populations. La réduction générale du tabagisme, moins importante dans les populations défavorisées, contribue à accroître encore ces inégalités et le tabagisme a tendance à se concentrer dans les populations les plus vulnérables. Les relations entre tabac et précarité sont examinées en identifiant, sur la base d’une revue de la littérature, les principaux facteurs communs de vulnérabilité : stress et adversité sociale, auto-stigmatisation, faible sentiment d’auto-efficacité, fonction sociale du tabagisme, ambivalence de la demande, addictions associées, sévérité de la dépendance au tabac, éloignement des dispositifs d’aide et de soins… Une attention spécifique est prêtée à certaines conditions particulières : troubles mentaux, addictions (hors-tabac), mal-logement, détention, migrations. Sur cette base, des pistes d’actions sont proposées pour améliorer l’accès aux soins et leur efficacité chez les personnes concernées. Un accent particulier est porté sur la mobilisation des professionnels qui ont souvent tendance à négliger les questions de tabagisme au regard de la sévérité immédiate des problèmes à l’origine de la demande des personnes accueillies. Une offre d’accompagnement à la réduction des risques (vapotage notamment) semble particulièrement adaptée à la demande souvent ambivalente des personnes. L’importance du travail en réseau et de l’implication des CSAPA/CAARUD est également soulignée. Sur le plan systémique, tout ceci doit s’accompagner d’un plaidoyer politique pour réduire ces inégalités et déterminants sociaux de santé.
Background
Trust is important to therapeutic relationships, influences patients’ motivation to seek care, cooperate during clinical examinations, adhere to treatment, return for follow-up, and facilitates exchange of health information. The aim of this study was to determine the influence of smoking status on patients’ trust in GPs, and how trust is related to willingness to act on advice to quit smoking.
Methods
A nationwide, online, cross-sectional survey was conducted among Australian smokers and ex-smokers aged 35 years and older. Participants were asked to rate their trust in GPs on a scale from 0 to 10, where 0 describes “you don’t trust GPs” and 10 describes “you trust GPs completely”. Multivariate linear and logistic regression analyses were used to test hypotheses.
Results
Responses from 886 respondents were analysed. Mean age was 60 years (± 9.5) and most were current smokers (69%). Trust scores were comparable for both smokers and ex-smokers (mean 7.6 (± 2.4)), but 39.4% were classified as having low trust (score < 8). Anticipated stigma was negatively associated with level of trust in GPs. Communication experience was positively associated with level of trust in GPs. Higher level of trust in GPs was associated with acceptance of advice to quit smoking.
Conclusion
Smokers and ex-smokers with higher levels of trust in their GPs reported more positive communication, and felt GPs advised them to quit smoking in a way that motivated them to quit. GP awareness with regard to anticipated stigma and experiences of communication amongst patients with a smoking history could improve provision of smoking cessation advice for this group.
Objective:
To explore tobacco-related knowledge and perceptions at Washington State (WA) agencies.
Methods:
Cross-sectional employee survey and qualitative focus groups with managers/supervisors. We produced descriptive statistics to examine differences in awareness and perceptions of tobacco-control efforts among employees and conducted a rapid thematic analysis of focus group data.
Results:
Of employees, only 18% with a history of tobacco use had utilized their agency's cessation benefits. Employees who did not use tobacco and who had higher education had more favorable attitudes toward tobacco-control efforts. In the focus groups, manager/supervisors described limited tobacco cessation promotion at their agency, barriers to tobacco control implementation, and concerns about the perceived effectiveness of additional tobacco-control efforts.
Conclusions:
States agencies should increase promotion of tobacco control policies and programs to increase awareness and reduce disparities in tobacco use.
The recent editorial, “Time to Stop Using the Word ‘Smoker’: Reflecting on the Role of Language in Advancing the Field of Nicotine and Tobacco Research,”¹ raises a number of important points about the use of language in nicotine and tobacco research. Language can indeed be important, and it is crucial to strive for precision in definitions and to use respectful terminology. However, I respectfully disagree with the call for person-first language as a solution to either of these issues. While the push for person-first language comes from a noble place, this terminology ultimately re-enforces stigma and may be actively harmful.
The push for person-first language emerges from a set of real problems. As succinctly explained in the editorial,¹ the historical terminology used to identify substance users was actively problematic. Terms were either simply slurs (ie, junkie), incorrect (“addict”--most users of most psychoactive substances are not addicted to or dependent on the substance) or both. It was unquestionably wrong, morally and scientifically, to use those terms. Stigma and stigmatizing causes real harms in an individual’s ability to address their substance use and harms associated with it as well as limiting the ability of public health and medicine to implement effective treatment and harm reduction.2,3
This study identified contributing factors for tobacco-related inequities among parents (N = 331) during COVID-19. Compared to non-Hispanic White parents, Asian, Black, and multiracial parents experienced greater discrimination. Parents with a nicotine use history experienced greater discrimination and substance use coping relative to tobacco abstainers. Among parents who used nicotine during the pandemic (n = 45), experiencing financial loss, having COVID-19, and greater worries were positively associated with nicotine reductions during COVID-19. Being female, increased family members with COVID-19, discrimination, and substance use coping were negatively associated with nicotine reductions. Tobacco interventions that reduce substance use coping and increase alternative coping are needed.
Stigma is often experienced by people affected by lung cancer due to the known links between lung cancer and smoking. Antitobacco campaigns, although attempting to “de-normalise” smoking, may contribute to stigmatising people affected by cancer. The study examined how people diagnosed with lung cancer recall and respond to antitobacco advertisements postdiagnosis. Sixteen qualitative semi-structured interviews were conducted with people with a lung cancer diagnosis who were recruited from an Australian clinical cancer registry. Interviews were analysed using thematic analysis. Participants mostly recalled narrative style antitobacco advertisements. A wide array of emotional responses to the advertisements were reported, including relief, shame, worry, discomfort, and resignation. Some participants avoided the advertisements altogether. Although some participants found the advertisements to be promoting stigma, others did not. Participants were not opposed to the broadcasting of antitobacco advertisements. Rather, the advertisements were perceived as appropriate and necessary. In conclusion, although people diagnosed with lung cancer reported experiencing some negative emotional responses to antitobacco advertising, they were supportive of its continuance.
Objective
Smoking stigmatization has been shown to hinder cigarette smoking cessation, especially among individuals with a strong smoker identity. Self-affirmation, a psychological threat-management coping strategy, can promote smoking cessation, and may mitigate the adverse consequences of stigmatization.
Design
Data from an online sample of 1,020 U.S. adult smokers were analyzed using multiple linear regression.
Main Outcome Measures
Participants completed a self-affirmation (or no-affirmation control) writing task before viewing a smoking stigma (or non-stigma control) anti-smoking PSA video. Participants then reported smoking-related cognitions and behavioral intentions.
Results
Among participants with strong—but not weak—ties to a smoker identity (smoking self-concept), self-affirming led to higher quit intentions compared to the control condition. Among participants with weak—but not strong—smoking self-concepts, those who self-affirmed had lower intentions to switch completely to e-cigarettes relative to the control condition. Exposure to stigmatization reduced intentions to seek cessation counseling, particularly among those with weak smoking self-concepts.
Conclusion
Findings demonstrate the critical role that smoking identity centrality plays in moderating reactions to both affirming and stigmatizing stimuli. Additional research is needed to better understand how self-affirmation and stigma-reduction interventions can be tailored and implemented in natural contexts.
Graphic cigarette warnings increase quit attempts. Perceived message effectiveness and message avoidance are predictive of later quit attempts. We sought to examine whether randomized exposure to warning messages would inadvertently increase intentions to use alternate tobacco products while enhancing attempts to quit cigarettes. An online survey of 1392 adult smokers in the US asked participants to rate six randomly selected tobacco warnings (from a set of 319) on perceived effectiveness and avoidance intentions. These two indicators of message effectiveness were calculated at the message-level and then at the individual campaign-level to facilitate causal inference. After viewing a message campaign of six warning messages, participants indicated their intentions to use alternate tobacco products. Sixty-eight percent of participants reported some intention to use e-cigarettes and intentions to use other alternate tobacco products ranged from 31% to 40%. Campaigns of messages eliciting higher avoidance increased the odds of intending to use hookah (aOR: 4.32), smokeless tobacco (aOR: 4.88), and snus (aOR: 8.06), but not the intention to use electronic cigarettes. These relationships are mediated by intentions to quit smoking (all p <.05). Viewing campaigns with higher campaign-level perceived effectiveness increased the intentions to quit, which in turn increased intentions to try alternate tobacco products. Our findings increase the tobacco control community’s understanding of unintended consequences of graphic tobacco warnings.
Introduction
Perceived stigma may be an unintended consequence of tobacco denormalization policies among remaining smokers. Little is known about the role of perceived stigmatization in cessation behaviours.
Aims
To test if perceived public smoker stigma is associated with recent attempts to cease smoking and future cessation plans among adult daily smokers.
Methods
Using merged data from the biennial national survey Norwegian Monitor 2011 and 2013 (N daily smokers = 1,029), we performed multinomial and ordinal regression analyses to study the impact of perceived public stigma (measured as social devaluation and personal devaluation) on recent quit attempts, short-term intention to quit and long-term intention to quit, controlling for confounders. One additional analysis was performed to investigate the relationship between stigma and intention to quit on quit attempts.
Results
A significant association between perceived social devaluation and recent quit attempts was found (OR 1.76). Perceived stigma was not associated with future quit plans. Personal devaluation was not associated with any cessation outcome. The role of perceived social devaluation on quit attempts was mainly found among smokers with intentions to quit.
Conclusion
These findings indicate that stigma measured as social devaluation of smokers is associated with recent quit attempts, but not with future quit plans.
Background:
Cigarette and e-cigarette use are prevalent among Canadian adolescents. Evidence shows psychiatric comorbidity with adolescent cigarette smoking, but little is known about psychological well-being among dual users of e-cigarettes and cigarettes. This study examined the association between dual-use status and psychological well-being among high school students.
Methods:
We used the 2016-2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Scales of psychological well-being (relatedness, autonomy, competency, prosocial behavior, and social responsiveness) were derived from self-reported data. Dual-use status was categorized into non-users, cigarette-only smokers, e-cigarette-only users, and four types of dual-users. Multivariable linear regression models examined the association between dual-use and psychological well-being.
Results:
Among the participants, 6.3% were current dual-users, 4.1% were cigarette-only smokers, 12.6% were e-cigarette-only users, and 77.0% were non-users. Compared to non-users, relatedness and social responsiveness were lower for all users. When compared to e-cigarette users, most other users had lower relatedness (high-frequency dual-users [β=-6.05], high-frequency cigarette dual-users [β=-2.27], high-frequency e-cigarette dual-users: [β=-1.32], low-frequency dual-users [β=-1.91], and cigarette-only smokers [β=-1.66]) and social responsiveness. High-frequency dual-users had lower scores for relatedness and social responsiveness, while high-frequency cigarette dual-users had higher autonomy, compared to low-frequency dual-users.
Conclusion:
Dual-users had poorer psychological well-being, which differed among dual-user sub-groups. This study highlights an opportunity for specialized programs to promote psychological well-being and reduce tobacco product use among adolescents.
Limitations:
The study is based on respondent self-report, and the use of cross-sectional data precludes us from determining the temporal order between dual-use and psychological well-being.
Research shows that smokers feel stigmatized, but does stigmatizing smokers do more harm than good? The model of stigma-induced identity threat was used to experimentally examine how U.S. and Danish smokers respond to stigma-relevant cues. Heavy smokers (112 Americans, 112 Danes) smoked a cigarette while giving a speech that was either video (stigma-visible condition) or audio recorded (stigma-concealed condition). Smokers high in self-concept reacted to the stigma-visible (as opposed to the stigma-concealed) condition with greater physiological reactivity (b = -2.80, p = .05), cognitive depletion (U.S. smokers, b = -0.06, p = .11), self-exempting beliefs (b = 0.32, p < .001), and less interest in stopping smoking (b = 0.28, p = .02). Thus, stigmatization led smokers toward emotional, cognitive, and attitudinal reactions that might make them less likely to quit. Future research should examine when smokers respond to stigmatization by quitting rather than with resistance or indifference.
It has been claimed that anti-smoking campaigns contribute to the stigmatization of smokers and that this stigma can have negative consequences. To explore this possibility, a survey of smokers (N = 207) was conducted in the context of the “Give me one lung cancer” campaign in South Korea. A path analysis revealed a positive relationship between campaign exposure and perceived stigma, suggesting that the campaign indeed exacerbated the stigma attached to smokers. Campaign exposure also had a positive effect on both autonomous and controlled motivation, which were partially mediated by perceived threat and perceived stigma. The positive and negative roles of perceived stigma were found: perceived stigma was positively related to controlled motivation and negatively related to autonomous motivation. As a result, the positive indirect effect of campaign exposure on autonomous motivation was diminished by its indirect effect via perceived stigma. The theoretical and practical implications of the results are discussed.
Reviews the book, Social stigma—The psychology of marked relationships by Edward Jones, Amerigo Farina, Albert Hastorf, Hazel Marks, Dale Miller, Robert Scott, and Rita French (1984). This book presents one of the more incisive analyses to date of the stigmatizing process. It is a scholarly and timely review of the literature examining the social and psychological factors of relationships between those who are "normal" and those who are "deviant" in some fashion. Individuals with differences—the disabled, the disfigured, ex-mental patients, and ex-convicts—are considered. The material presented is relevant for the social scientist exploring the vicissitudes of stereotyping, and also for the practicing clinician attempting to deal with the daily demands of rehabilitation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A convicted criminal suffers not only from public penalties but from stigma, the reluctance of others to interact with him economically and socially. Conviction can convey useful information about the convicted, which makes stigmatization an important and legitimate function of the criminal justice system quite apart from moral considerations. The magnitude of stigma depends on expectations and the crime rate, however, which can lead to multiple, Pareto-ranked equilibria with different amounts of crime. Copyright 1996 by the University of Chicago.
Modified labeling theorists have long argued that the stigma of mental illness has important consequences for the lives of people with mental illness. We propose that social rejection is an enduring force in the lives of people with mental illness and that these experiences are central to understanding the poor self-concepts described by many former psychiatric patients. We explore changes in a cohort of recently deinstitutionalized mental patients' (N = 88) self-esteem and experiences with social rejection using data from a three wave panel survey conducted while institutionalized and over a two-year period following the patients' discharge from a long-term state hospital. Our results indicate that social rejection is a persistent source of social stress for the discharged patients. Moreover, these experiences increase feelings of self-deprecation that, in turn, weaken their sense of mastery. Where the patients' received their follow-up care--whether in a community setting or in another state hospital--had little impact on their self-related feelings or on their experiences of social rejection. Our results provide further support for modified labeling theory and underscore the need to consider the dynamic relationship between stigmatizing experiences and self-related changes.
This paper explores the relationships among neighborhood disadvantage, stress, and the likelihood of drug use in a sample of adults (N = 1,101). Using the 1995 Detroit Area Study in conjunction with tract-level data from the 1990 census, we find a positive relationship between neighborhood disadvantage and drug use, and this relationship remains statistically significant net of controls for individual-level socioeconomic status. Neighborhood disadvantage is moderately associated with drug related behaviors, indirectly through increased social stressors and higher levels of psychological distress among residents of disadvantaged neighborhoods. A residual effect of neighborhood disadvantage remains, net of a large number of socially relevant controls. Finally, results from interactive models suggest that the relationship between neighborhood disadvantage and drug use is most pronounced among individuals with lower incomes.
To quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases.
Systematic review with a random effects meta-analysis.
26 studies on the effects of smoke-free workplaces.
Workplaces in the United States, Australia, Canada, and Germany.
Employees in unrestricted and totally smoke-free workplaces.
Daily cigarette consumption (per smoker and per employee) and smoking prevalence.
Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from 3.05 (0.78 euro to 3.14 euro) in the United States and from 3.44 pounds sterling to 6.59 pounds sterling (5.32 euro to 10.20 euro) in the United Kingdom. If all workplaces became smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry 1.11 and 4.26 pounds sterling.
Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption.
To examine divergent estimates of smoking prevalence in two random digit dial surveys for the same population. Based upon internal and external reviews of survey procedures, differences in survey introductions (general health versus tobacco specific introduction) and/or differences in the use of filter questions were identified as the most likely explanations. This prompted an experiment designed to investigate these potential sources of measurement error.
A randomised 2 x 2 factorial experiment.
A random digit dial telephone survey from July to September 2000.
3996 adult Californian respondents.
A series of smoking prevalence questions in the context of a tobacco or general health survey.
Logistic regression analyses suggest that, among females, prior knowledge (from the survey introduction) that a survey is concerned with tobacco use may decrease self reported smoking prevalence (approximately 4% absolute prevalence difference). Differences in the use of filter questions resulted in almost no misclassification of respondents.
The tobacco specific survey introduction is causing some smokers to deny their tobacco use. The data suggest that these smokers tend to be women that smoked occasionally. A desire by the participants to minimise their personal time costs or a growing social disapproval of tobacco use in the USA may be contributing to the creation of previously undetected survey artefacts in the measurement of tobacco related behaviours.
To draw on narrative interviews with patients with lung cancer and to explore their perceptions and experience of stigma.
Qualitative study.
United Kingdom.
45 patients with lung cancer recruited through several sources.
Participants experienced stigma commonly felt by patients with other types of cancer, but, whether they smoked or not, they felt particularly stigmatised because the disease is so strongly associated with smoking. Interaction with family, friends, and doctors was often affected as a result, and many patients, particularly those who had stopped smoking years ago or had never smoked, felt unjustly blamed for their illness. Those who resisted victim blaming maintained that the real culprits were tobacco companies with unscrupulous policies. Some patients concealed their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people. Some indicated that newspaper and television reports may have added to the stigma: television advertisements aim to put young people off tobacco, but they usually portray a dreadful death, which may exacerbate fear and anxiety. A few patients were worried that diagnosis, access to care, and research into lung cancer might be adversely affected by the stigma attached to the disease and those who smoke.
Patients with lung cancer report stigmatisation with far reaching consequences. Efforts to help people to quit smoking are important, but clinical and educational interventions should be presented with care so as not to add to the stigma experienced by patients with lung cancer and other smoking related diseases.
Education has been identified as a potent sociodemographic predictor of smoking cessation and the Healthy People 2010 goals include the elimination of health disparities attributable to education.
The current study prospectively examined the association of education with smoking cessation as well variables that might account for that association among employed adults residing in the southeastern United States.
A strong educational gradient in cessation was evident. Only 6% of smokers with less than a high school (HS) degree quit smoking during the 4-year study period, whereas 17% of smokers with a HS degree but no college degree and 28% of smokers with at least a college degree quit smoking.
Education appeared to uniquely contribute to the prediction of smoking abstinence over and above the effects of demographic, environmental, tobacco dependence, transtheoretical model, and job-related variables. Obtaining a better understanding of how or why education influences smoking cessation could contribute to reducing the educational gradient in abstinence and warrants further research attention.
We sought to determine the impact of comprehensive tobacco control measures in New York City.
In 2002, New York City implemented a tobacco control strategy of (1) increased cigarette excise taxes; (2) legal action that made virtually all work-places, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking.
From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US-born and foreign-born persons; and in all 5 boroughs. Increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third.
Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing.
To describe tobacco industry consumer research to inform the development of more "socially acceptable" cigarette products since the 1970s.
Analysis of previously secret tobacco industry documents.
28 projects to develop more socially acceptable cigarettes were identified from Philip Morris, RJ Reynolds, British American Tobacco, and Lorillard tobacco companies. Consumer research and concept testing consistently demonstrated that many smokers feel strong social pressure not to smoke, and this pressure increased with exposure to smoking restrictions. Tobacco companies attempted to develop more socially acceptable cigarettes with less visible sidestream smoke or less odour. When presented in theory, these product concepts were very attractive to important segments of the smoking population. However, almost every product developed was unacceptable in actual product tests or test markets. Smokers reported the complete elimination of secondhand smoke was necessary to satisfy non-smokers. Smokers have also been generally unwilling to sacrifice their own smoking satisfaction for the benefit of others. Many smokers prefer smoke-free environments to cigarettes that produce less secondhand smoke.
Concerns about secondhand smoke and clean indoor air policies have a powerful effect on the social acceptability of smoking. Historically, the tobacco industry has been unable to counter these effects by developing more socially acceptable cigarettes. These data suggest that educating smokers about the health dangers of secondhand smoke and promoting clean indoor air policies has been difficult for the tobacco industry to counter with new products, and that every effort should be made to pursue these strategies.
The International Tobacco Control (ITC) Four Country Survey (ITC-4) is a prospective cohort study designed to evaluate the psychosocial and behavioural impact of national-level tobacco control policies enacted in the Australia, Canada, the UK, and the USA. Wave 1 of ITC-4 survey was conducted between October 2002 and December 2002. Wave 2 survey was conducted between May 2003 and August 2003.
To test for individual-level predictors of smoking cessation behaviours (that is, quit attempts and smoking cessation) among cigarette smokers in the ITC Four Country Study measured between Wave 1 and Wave 2. This set of predictors will serve as the base for evaluating the added effect of tobacco control policies and other factors.
Respondents included in this study are 6682 adult current smokers in the Wave 1 main survey who completed the Wave 2 follow-up (1665 were in Canada, 1329 were in the USA, 1837 were in the UK and 1851 were in Australia).
Factors predictive of making a quit attempt included intention to quit, making a quit attempt in the previous year, longer duration of past quit attempts, less nicotine dependence, more negative attitudes about smoking, and younger age. Lower levels of nicotine dependence were the main factor that predicted future cessation among those that made a quit attempt.
Intention to quit and other cognitive variables were associated with quit attempts, but not cessation. Behavioural variables related to task difficulty, including measures of dependence, predicted both making attempts and their success. Predictors of making quit attempts and cessation were similar for each of the four countries, but there were some differences in predictors of success.
Taxes on cigarettes have long been used to help reduce cigarette consumption. Social factors also affect cigarette consumption, but this impact has not been quantified. We computed a social unacceptability index based on individuals’ responses to questions regarding locations where smoking should be allowed.
A regression analysis showed that the social unacceptability index and price had similar elasticities and that their effects were independent of each other. If, through an active tobacco control campaign, the average individual’s views on the social unacceptability of smoking changed to more closely resemble the views of California residents, there would be a 15% drop in cigarette consumption, equivalent to a $1.17 increase in the excise tax on cigarettes.
In addition to common stressors, members of the U.S. Armed Forces experience a high level of stress unique to their status as service members. In an effort to combat stress, many military personnel report high levels of nicotine use. This study investigated the relationship between tobacco use and perceived stress among military members in all four armed services. Results indicate that those who use tobacco products specifically to reduce stress report significantly higher stress levels than those who do not use tobacco. Moreover, current users and those who both smoked and used smokeless tobacco were far more likely to report experiencing "a lot" of stress from a variety of sources than former or never users. Tobacco users also engaged more frequently in negative coping behaviors and relied less on the positive coping strategies used more often by former or never smokers. These findings are consistent with the larger body of literature suggesting that tobacco is not only an ineffective stress-reducing strategy, it also likely perpetuates a stress response in users. It is, therefore, critical that the military improve effective means of coping among nicotine-using troops.
Critics of labeling theory vigorously dispute Scheff's (1966) provocative etiological hypothesis and downplay the importance of factors such as stigma and stereotyping. We propose a modified labeling perspective which claims that even if labeling does not directly produce mental disorder, it can lead to negative outcomes. Our approach asserts that socialization leads individuals to develop a set of beliefs about how most people treat mental patients. When individuals enter treatment, these beliefs take on new meaning. The more patients believe that they will be devalued and discriminated against, the more they feel threatened by interacting with others. They may keep their treatment a secret, try to educate others about their situation, or withdraw from social contacts that they perceive as potentially rejecting. Such strategies can lead to negative consequences for social support networks, jobs, and self-esteem. We test this modified labeling perspective using samples of patients and untreated community residents, and find that both believe that "most people" will reject mental patients. Additionally, patients endorse strategies of secrecy, withdrawal, and education to cope with the threat they perceive. Finally, patients' social support networks are affected by the extent to which they fear rejection and by the coping responses they adopt to deal with their stigmatized status.
Labeling theory proponents and the theory's critics have different views of stigma and thus differ on the consequences of labeling for people with mental illness. The labeling perspective posits that because of stigma, official labeling through treatment contact has negative consequences for mental patients. In contrast, critics of labeling theory claim that stigma is relatively inconsequential. Instead, they argue that because labeling results in receiving needed services, it provides significant benefits for mental patients. Thus far, no study has tested the relative positive and negative effects of labeling. I examine these views by comparing the importance of perceived stigma versus the receipt of services for the quality of life of persons with chronic mental illness. Results show that both stigma and services received are significantly associated with quality of life, but in opposite ways. These findings have important implications for interventions for mental illness.
This article focuses on the long-standing, but recently intensified controversy over cigarette smoking. In the late 1960s and the 1970s a variety of laws and regulations were implemented to regulate smoking and the smoker. Initially these strictures were what Gusfield terms assimilative, but more recently they have become coercive. In 1978, for example, a California referendum to ban smoking in most public places was narrowly defeated. Many view this controversy using a medical model or emphasizing the conflicting rights of smokers and nonsmokers. We analyze it as a status battle between pro and antismoking vested interests. Using data from a variety of primary and secondary sources such as government statistics, corporate reports, state codes, marketing reports and public opinion polls, we focus on the political, economic and organizational forces which have militated for or against changes. At stake is the symbolic definition of a behavior as socially approved or illegitimate and the consequent denigration of the losers. We predict more and increasingly militant confrontations between pro and antismoking forces, both at the individual and collective level.
Social science research on stigma has grown dramatically over the past two decades, particularly in social psychology, where researchers have elucidated the ways in which people construct cognitive categories and link those categories to stereotyped beliefs. In the midst of this growth, the stigma concept has been criticized as being too vaguely defined and individually focused. In response to these criticisms, we define stigma as the co-occurrence of its components–labeling, stereotyping, separation, status loss, and discrimination–and further indicate that for stigmatization to occur, power must be exercised. The stigma concept we construct has implications for understanding several core issues in stigma research, ranging from the definition of the concept to the reasons stigma sometimes represents a very persistent predicament in the lives of persons affected by it. Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people's li...
The 1st and 2nd editions of this book (1966, 1984) presented a sociological theory of mental disorder (MD). Seeing MD from the point of view of a single discipline, the theory was 1-dimensional. Since then, there have been substantial advances in the biology, psychology, and even in the sociology of MD. What is now most needed is an interdisciplinary approach, one that would integrate the disparate viewpoints and findings of the relevant disciplines.
Given the need for consilience (i.e., the interlocking of frameworks from the relevant disciplines), is there any point in resurrecting labeling theory, yet another 1-dimensional approach to the complex problem of MD? The author's decision that labeling theory still has value was based on the following ideas. First, while waiting for consilient approaches to be developed, headways can still be made with 1- or 2-dimensional approaches. A 2nd idea is that biopsychiatry, the dominant force in the field, like all disciplines, accentuates the positive. Labeling theory can be considered to be a countertheory, critical of the weakest points in the dominant theory, and focusing on issues that it neglects.
This edition attempts to provide a clear statement of a sociological approach to MD and integrate it with other approaches. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This article formulates job search models, incorporating certain types of the "stigma" effect of unemployment. It is assumed that the probability of getting a job offer, given the unemployment individual contacts the firm, is influenced by the duration of unemployment and is justified in a signaling context. The optimal search is analyzed for one sector, as well as across several independent labor-market segments. It is shown that there are reasonably general conditions on the search environments, for which both the individual reservation wage and escape rate are negative-duration dependent, a fact observed in empirical studies. Copyright 1989 by University of Chicago Press.
To assess long-term trends in cigarette smoking according to the combined influence of sex and education, this study examined smoking prevalence in successive US birth cohorts.
Data from nationally representative surveys were examined to assess smoking prevalence for six successive 10-year birth cohorts stratified by race or ethnicity, sex, and educational attainment.
Substantial declines in smoking prevalence were found among men who had a high school education or more, regardless of race or ethnicity, and slight declines among women of the same educational background were revealed. However, little change was found in smoking prevalence among men of all race/ethnic groups with less than a high school education, and large increases were found among women with the same years of schooling, especially if they were White or African American.
These data suggest that persons of low educational attainment have yet to benefit from policies and education about the health consequences of cigarette smoking.
Numerous studies have demonstrated a strong connection between the experience of stigma and the well-being of the stigmatized. But in the area of mental illness there has been controversy surrounding the magnitude and duration of the effects of labeling and stigma. One of the arguments that has been used to downplay the importance of these factors is the substantial body of evidence suggesting that labeling leads to positive effects through mental health treatment. However, as Rosenfield (1997) points out, labeling can simultaneously induce both positive consequences through treatment and negative consequences through stigma. In this study we test whether stigma has enduring effects on well-being by interviewing 84 men with dual diagnoses of mental disorder and substance abuse at two points in time--at entry into treatment, when they were addicted to drugs and had many psychiatric symptoms and then again after a year of treatment, when they were far less symptomatic and largely drug- and alcohol-free. We found a relatively strong and enduring effect of stigma on well-being. This finding indicates that stigma continues to complicate the lives of the stigmatized even as treatment improves their symptoms and functioning. It follows that if health professionals want to maximize the well-being of the people they treat, they must address stigma as a separate and important factor in its own right.
HIV/AIDS is catastrophic both from a public health perspective and in terms of its impact on economic and social stability in many of the most severely affected nations, including virtually all of southern Africa. A public health response alone is insufficient to address this devastating epidemic. Political leadership at the highest levels is needed to mobilize a multisectoral response to the impact of HIV/AIDS on educational systems, industry, agriculture, the military, and other sectors. With a few notable exceptions, political response was slow to mobilize in the early years of the epidemic, but response has dramatically improved in the past 18 months. The Joint United Nations Programme on HIV/AIDS (UNAIDS) is involved in ongoing efforts to encourage political leaders to make a multisectoral response to the epidemic a major focus of their national plans.
Following a critical appraisal of the conceptual treatment of norms in sociological literature, a typology of norms is presented. The typology treats collective evaluations of behavior, collective expectations of behavior, and reactions of behavior as the basic normative dimensions. These dimensions generate a total of nineteen types of norms, four of which are possible null classes.
This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.
We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures.
We analyzed data from the 2000 National Health Interview Survey.
Overall, the prevalence of current smoking was greatest among persons in--and independently associated with--working class jobs, low educational level, and low income. Attempts to quit showed no socioeconomic gradient, while success in quitting was greatest among those with the most socioeconomic resources. These patterns held in most but not all race/ethnicity-gender groups. Finer resolution of smoking patterns was obtained using a relational UK occupational measure, compared to the skill-based measure commonly used in US studies.
Reducing social disparities in smoking requires attention to the complexities of class along with race/ethnicity and gender.
The AIDS epidemic has borne witness to the terrible burdens imposed by stigmatization and to the way in which marginalization could subvert the goals of HIV prevention. Out of that experience, and propelled by the linkage of public health and human rights, came the commonplace assertion that stigmatization was a retrograde force.
Yet, strikingly, the antitobacco movement has fostered a social transformation that involves the stigmatization of smokers. Does this transformation represent a troubling outcome of efforts to limit tobacco use and its associated morbidity and mortality; an ineffective, counterproductive, and moralizing approach that leads to a dead end; or a signal of public health achievement? If the latter is the case, are there unacknowledged costs?
Participation rates for epidemiologic studies have been declining during the past 30 years with even steeper declines in recent years. This wholesale decrease in participation rate, or at the very least the increase in refusal, has, quite understandably, occasioned some concern among epidemiologists who have long considered a high study participation rate as one of the hallmarks of a "good" epidemiologic study. In this review we synthesize the issues that are central to epidemiologic thinking around declining study participation rates. We consider the reasons why study participation has been declining, summarize what we know about who does participate in epidemiologic studies, and discuss the implications of declining participation rates. We conclude with a discussion of methods that may help improve study participation rates.
An increase in the social unacceptability of smoking has dramatically decreased tobacco use in the USA. However, how policies (e.g., smoke free air laws) and social factors (e.g., social norms) drive the social unacceptability of tobacco use are not well understood. New research suggests that the stigmatization of smokers is an unrecognized force in the tobacco epidemic and could be one such mechanism. Thus, it is important to investigate the sources of smoker-related stigmatization as perceived by current and former smokers. In this study, we draw on the broader literature about stigma formation in the context of the tobacco epidemic and examine the role of attribution, fear, tobacco control policies, power and social norms in the formation of smoker-related stigma. We test hypotheses about the determinants of stigma using a population-based sample of 816 current and former smokers in New York City. The results show that perceptions of individual attributions for smoking behavior and fear about the health consequences of second hand smoke are important influences on smoker-related stigmatization. Structural forms of discrimination perpetrated against smokers and former smokers (e.g., company policies against hiring smokers) are also related to smoker-related stigma. Respondents with more education perceive more smoker-related stigma than respondents with less education and, Black and Latino respondents perceive less smoker-related stigma than White respondents. Social norms, specifically family and friends' expressed disapproval of smoking, contribute to the formation of smoker-related stigma. These findings suggest important points of leverage to harness the powerful role of stigma in the smoking epidemic and raise concerns about the possible role of stigma in the production of smoking disparities.
Morality and Health. New York: Routledge. Centers for Disease Control and Prevention
- Allan M Brandt
- Paul Rozin
Brandt, Allan M., and Paul Rozin. 1997. Morality and Health. New York: Routledge.
Centers for Disease Control and Prevention. 2002. "Cigarette Smoking among Adults-United States, 2000." Morbidity and Mortality Weekly Report 51, no. 29 ( July 26): 642-45.
Lifestyle Discrimination in the Workplace
National Workrights Institute. 1994. "Lifestyle Discrimination in the Workplace." Legislative Brief. National Workrights Institute, Princeton, NJ. http://www.workrights.org/
issue_lifestyle/ld_legislative_brief.html.
Results from the 2008 National Survey on Drug Use and Health: National Findings
SAMHSA (Substance Abuse and Mental Health Services Administration), Office of Applied
Studies. 2009. Results from the 2008 National Survey on Drug Use and Health: National
Findings. National Survey on Drug Use and Health Report, Series H-36, USDHHS
Publication no. SMA 09-4434. Rockville, MD: SAMHSA.
USDHHS, Public Health Service, Centers for Disease Prevention and Health Promotion
USDHHS (U.S. Department of Health and Human Services), Surgeon General. 1989.
Reducing the Health Consequences of Smoking: 25 Years of Progress; A Report of the Surgeon
General. Report no. CDC 89-8411. Washington, DC: USDHHS, Public Health Service,
Centers for Disease Prevention and Health Promotion, Office on Smoking and Health.