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Markers of the Denormalisation of Smoking and the Tobacco Industry

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Abstract

In nations with histories of declining smoking prevalence and comprehensive tobacco control policies, smoking-positive cultures have been severely eroded. Smoking, smokers and the tobacco industry are today routinely depicted in everyday discourse and media representations in a variety of overwhelmingly negative ways. Several authors have invoked Erving Goffman's notions of stigmatization to describe the process and impact of this radical transformation, which importantly includes motivating smoking cessation. Efforts to describe nations' progress toward comprehensive tobacco control have hitherto taken little account of the role of cultural change to the meaning of smoking and the many ways in which it has become denormalised. This paper identifies a diversity of generally undocumented yet pervasive markers of the "spoiled identity" of smoking, smokers and the tobacco industry, illustrated with examples from Australia, a nation with advanced tobacco control. We caution about some important negative consequences arising from the stigmatization of smokers. We recommend that schemes rating the comprehensiveness of national tobacco control should be supplemented by documentation of markers of this denormalisation.

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... They are described as being selfish, thoughtless and undereducated. 4,10 Smokers are also subjected to social rejection and are regarded as undesirable housemates, 4 bad employees 4,11 and unattractive love interests. 4,12 Smokers themselves perceive this social disapproval 13 in family members, co-workers, healthcare providers and even strangers. ...
... 4,10 Smokers are also subjected to social rejection and are regarded as undesirable housemates, 4 bad employees 4,11 and unattractive love interests. 4,12 Smokers themselves perceive this social disapproval 13 in family members, co-workers, healthcare providers and even strangers. 14 Whereas smoking has diminished in French men from 1980 (51.5%) to 2012 (34.4%), it has increased substantially in French women over the same period (18.8%-27.7%). ...
... 23 Moreover, results regarding avoidance and rejection are in accordance with the literature, which shows that smokers are seen as undesirable persons. 4,11,12,63 It is especially important when considering that social network and support work in favour of both good postnatal mental health 64 and smoking cessation. 65 Generally, our results support the idea that smoking during pregnancy is mostly seen as reprehensible 21,44 and that this view motivates various punitive behaviours. ...
Article
Introduction Cigarette consumption during pregnancy has major health consequences for women and unborn children. The stigma of smoking during pregnancy might hinder mothers-to-be’s access to adequate healthcare and smoking cessation, especially in disadvantaged groups. This qualitative study was designed to describe extensively the public stigma associated with smoking during pregnancy. Method Participants were French adults recruited from the general population through social networks (N=100). They were asked to answer three pairs of open-ended questions regarding cognitions, emotions and behaviours elicited in the general population by pregnant smoking women. An inductive thematic analysis was performed and inter-judge agreement was computed on 30% of the corpus analysed deductively. Finally, independence (chi-square) between themes and gender, education, parenthood and smoking status was tested. Results Themes (n=25) were defined regarding cognitions (n=9, e.g., irresponsible, thoughtless and unmindful, etc.), emotions (n=8, e.g., anger, disgust, etc.) and behaviours (n=8, e.g., inform and persuade, moralise and blame, etc.). Global inter-judge agreement was strong (κ=0.8). No difference was observed in themes according to gender, parental status or education, indicating a heterogenous awareness of stigma. However, some differences were observed according to smoking status (χ2 = 69.59, p = 0.02) (e.g., non-smokers more frequently stressed immorality). Conclusion The stigma associated with smoking during pregnancy includes various components that might be measured and targeted in interventions to improve access to adequate healthcare and smoking cessation in this specific population. Implications This qualitative study explores the stigma that the general French population attaches to pregnant women who smoke. Themes regarding cognitions (e.g., irresponsible, thoughtless and unmindful, etc.), emotions (e.g., anger, disgust, etc.) and behaviours (e.g., inform and persuade, moralise and blame, etc.) were identified. These themes could guide further research regarding scale development and anti-stigma interventions to support smoking cessation.
... E-cigarette use may represent a significant threat to tobacco control through the undermining of denormalisation, even or especially in societies which are strongly denormalised. This may occur, in part at least, through a paring back of what Chapman and Freeman (2008) call the 'spoiled identity' [57] of smokers, operationalized in many markers visible among Australian tobacco users. Smokers' spoiled identities have been compounded by the 'relentless tide of bad news' [57] about smoking carrying numerous subtexts about smokers as undereducated, malodorous, excessive users of public health services, selfish and thoughtless, and as employer liabilities. ...
... This may occur, in part at least, through a paring back of what Chapman and Freeman (2008) call the 'spoiled identity' [57] of smokers, operationalized in many markers visible among Australian tobacco users. Smokers' spoiled identities have been compounded by the 'relentless tide of bad news' [57] about smoking carrying numerous subtexts about smokers as undereducated, malodorous, excessive users of public health services, selfish and thoughtless, and as employer liabilities. Like Australia, Ireland is a country with progressive tobacco control legislation and regulation, and smoking is banned in all workplaces and increasingly in outdoor areas where there are children as in playgrounds, as well as on public transport. ...
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Background Smoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people’s accounts of e-cigarette use in Ireland. Methods Semi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18–22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or ex-smokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis. Results Three broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, "greater addictiveness", product taste, and device faults. Putative cessation refers to the conflict between participants' expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes’ failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit e-cigarettes. Conclusions Participants were sceptical about e-cigarettes’ "purported relative healthiness", concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people's use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers.
... A number of studies have shown that extraversion, which is associated with larger social networks and increased social interaction [e.g., 34,35,36] is positively associated with smoking [29,[37][38][39] and alcohol consumption [21,40]. Some researchers have noted that the association between smoking and extraversion has decreased in recent decades [41][42][43]. One of the possible explanations is that smoking has become a non-normative behavior as more people have become aware of the adverse consequences of smoking [44]. ...
... We found that women with higher levels of extraversion were also more likely to use alcohol prior to pregnancy but were less likely to smoke. Although these results are contrary to some older findings where extraversion was strongly related to smoking, they confirm more recent findings that the association between extraversion and smoking has become weak in recent years [41][42][43]. This shift may reflect today's attitudes toward smoking and the raising awareness of the adverse consequences of smoking. ...
Article
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Cigarette smoking and alcohol consumption during pregnancy can have detrimental effects on the developing fetus, including fetal alcohol syndrome and low birth weight. Surprisingly little is known about the association of personality traits with smoking and alcohol consumption in the specific subpopulation of pregnant women. This study analyzed data from a geographically diverse sample of 603 pregnant women, aged 18 years and older, who provided information regarding their smoking and drinking habits before and during pregnancy. We compared women who consumed alcohol or smoked cigarettes before pregnancy with women who quit or continued smoking or drinking during pregnancy. Associations between personality and maladaptive behaviors prior to and during pregnancy were modeled using logistic regression. The study revealed that women who scored high on openness to experience were significantly more likely to continue alcohol consumption during pregnancy (OR = 1.07, 95% CI 1.01, 1.14, p = .02). This association was maintained after adjusting for potential confounds. This study demonstrated a significant relationship between personality traits and women’s likelihood of continued alcohol consumption prior to and during pregnancy. Understanding personality-based determinants of health-detrimental behavior is important in order to design interventions that aim at decreasing rates of maladaptive health behaviors among pregnant women.
... Tobacco smoking is the leading preventable cause of death and disease worldwide, killing over seven million people annually (World Health Organization [WHO], 2018). In many countries, increasingly comprehensive tobacco control policies have been implemented with the aim of "denormalizing" smoking and reducing smoking prevalence (Chapman and Freeman, 2008;Dubray et al., 2015). However, the nicotine market has changed with the introduction of vaping devices (also called e-cigarettes; Hon, 2003) and there has been considerable discussion with regards to the impact of vaping on smoking norms and behavior. ...
... Drug and Alcohol Dependence 205 (2019) 107635 monitored alongside prevalence to explore whether pro-vaping norms could precede any changes in vaping, or smoking. Friend smoking and peer approval of smoking were more commonly reported by smokers, adding to the large body of evidence that smoking norms influence smoking behavior (Chang et al., 2006;Chapman and Freeman, 2008;Conner et al., 2017;Lotrean et al., 2013;Van De Ven et al., 2007). Friend vaping and peer approval of vaping were more commonly reported by vapers, also similar to previous studies (Gorukanti et al., 2017;Lozano et al., 2019;Thrasher et al., 2016). ...
Article
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Background: This study assesses differences in social norms towards smoking and vaping among youth across countries (England, Canada, US) and smoking and vaping status. Methods: Data are from the 2017 ITC Youth Tobacco and Vaping Survey, among youth age 16-19 in England (N = 3444), Canada (N = 3327), and US (N = 3509). Prevalence of friend smoking, friend vaping, peer approval of smoking, and peer approval of vaping were estimated. Adjusted logistic regression models were estimated for each norm to assess associations with country, smoking status, and vaping status, adjusting for sociodemographics, alcohol use, and marijuana use. Results: 47% and 52% reported friend smoking and vaping respectively. Perceived peer approval of vaping (44%) was almost double that of smoking (23%). Compared with England, fewer Canadian and US youth reported friend smoking (Canada: AOR = 0.71 [95% CI = 0.62-0.82]; US: AOR = 0.54 [0.47-0.62]) and peer approval of smoking (Canada: AOR = 0.74 [0.63-0.87]; US: AOR = 0.78 [0.67-0.91]), yet more reported peer approval of vaping (Canada: AOR = 1.23 [1.08-1.41]; US: AOR = 1.30 [1.14-1.48]). More Canadian than English youth reported friend vaping (AOR = 1.17 [1.02-1.36]). Friend smoking, peer approval of smoking, and friend vaping were more common among smokers and vapers (all p < .02). Peer approval of vaping was more common among vapers but less common among smokers (all p < .044). Conclusions: Youth had more positive vaping than smoking norms. English youth reported the most pro-smoking but least pro-vaping norms in adjusted models; this was unexpected given country differences in regulatory environments. Norms towards both products were associated with use, with some evidence of cross-product associations between norms and behaviours.
... Disse fire «kunnskapsbegivenhetene» har samlet sett inspirert og legitimert en rekke nye tiltak mot røyking og innstramminger i lovgivningen fra 1980-tallet og framover. Selv om det ikke alltid har vaert tydelig artikulert i grunngivingen for politikken, kan disse tilstrammingene i regulering av røyking sies å vaere grunnlagt på en idè om «denormalisering» av tobakksatferd og en tilhørende forsterking av røykefrihetsnormen (Chapman & Freeman, 2008). Denormalisering betyr i denne sammenhengen at røyking ikke skal vaere normalt, og heller ikke akseptabelt (Hammond et al., 2006). ...
... Man kan si at denne kontrollpolitikken har virket. Den har i hvert fall gitt sitt bidrag til en sosiokulturell dreining i det normative klimaet for røyking som igjen henger sammen med at andelen røykere i befolkningen har blitt betydelig redusert (Chapman & Freeman, 2008;Saebø 2012b). ...
... Therefore, given the dominance of personal responsibility in gamblers' responses, we would argue that governments have a legislated obligation to move beyond and away from the promotion of responsible gambling paradigms to address the broader determinants of harm. As has been clearly demonstrated in other areas of public health, strong curbs on marketing, the regulation of products (including the components and ingredients), and the right to honest information about the products create conditions which support individuals to engage in 'responsible' ways without compromising individual freedom and choice [80][81][82] are all important components of a comprehensive public health approach. These universal protections may also help to prevent the negative health outcomes and stigma that may eventuate from not being able to be 'responsible' with gambling [24], and money [26]. ...
... This will help to support a broader legislative response, thus changing the social norms relating to gambling rather than focusing almost exclusively on the individual's role in behaviour change. This type of refocusing has been effective in the tobacco arena in which there has been a substantial shift in tobacco control activity to exposing the activities and approaches of the industry -not just as part of advocacy but as a strong argument to cease or never start smoking [82][83][84]. While this study shows that some gamblers are critical of government involvement in what they consider are personal decisions, Moore and colleagues [2015] have described how government interventions could be reframed as providing freedom from the domination of industry by restricting exploitative industry behaviour rather than reducing personal freedoms [85]. ...
Article
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Background Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm. Methods A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted. Results Six common tropes were constructed from gamblers’ responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action – but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices. Conclusions This study demonstrates that gamblers’ perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from ‘responsible gambling’ messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.
... Most were revealed to me primarily via their engagement with cigarettes. This, of course, is only one way of identifying smokers in what is indubitably the current climate of tobacco denormalization in Australia (see Chapman and Freeman 2008 ;Winstanley 2012 ). As Bell et al. (2010) have pointed out, smoking in public in a climate where stigmatization is common may be difficult or even impossible for some smokers. ...
... Det har for eksempel blitt publisert flere studier de siste årene som viser hvordan røykere føler seg negativt stemplet Stuber m fl, 2008; McCool m fl, 2012) og utestengt fra stadig flere sosiale arenaer (Bell m fl, 2010). I mange av studiene stilles det spørsmål om det kan vaere slik at selv om et normklima som er negativt til røyking trolig stimulerer mange til røykeslutt, kan det også produsere en følelse av mislykkethet samt økt motstand blant dem som ikke lykkes Chapman & Freeman, 2008;Stuber m fl, 2009;Greaves m fl, 2010)? Til nå har det i liten grad blitt gjort norske studier som fokuserer på slike problemstillinger. ...
Chapter
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Antologien belyser røykeres erfaringer med denormaliseringsstrategier i tobakkspolitikken, ut fra deres situasjon, sosiale posisjon og perspektiv. Bidragene illustrerer ulike aspekter ved det å bruke et helsefarlig produkt som i tiltakende grad oppfattes som sosialt uakseptabelt, og som er omgitt med stadig strengere regulering. Spørsmål som belyses er hvilken oppslutning og støtte ulike tiltak har blant dagens tobakksbrukere, og hva tobakkspolitikken og det røykefiendtlige klimaet synes å gjøre med brukernes selvforståelse og sosiale relasjoner. Innledningsvis gjøres det rede for hva vi forstår med denormalisering av røyking og røykere, og hvordan ideen om denormalisering har preget mye av tobakkskontrollarbeidet i Norge og i vesten forøvrig. Dette kan karakteriseres som en effektiv politikk, i den forstand at andelen røykere i befolkningen er drevet betydelig ned de siste tiårene. Samtidig kommer det nå fra flere land signaler om at denne politikken synes å ha noen uintenderte konsekvenser for de gjenværende røykerne, særlig i form av opplevd devaluering og stigmatisering. Med utgangspunkt i slike funn, og de mulige dysfunksjonelle effektene av en restriktiv politikk de kan indikere, tas det til orde for at tobakksforskningen bør gi større plass til utforsking av røykernes selvforståelse enn det som er tilfelle i dag. Rapporten presenterer fem empiriske analyser basert på et slikt brukerperspektiv. For å sikre seg at politikken som vedtas i et samfunn blir gjennomslagskraftig, er det viktig å undersøke om den har oppslutning, ikke bare i befolkningen som helhet, men også blant dem som styres. Karl Erik Lund viser i sin artikkel «Røykernes motstand til nye tobakksforebyggende tiltak» at en stor andel av dagens røykere er sterkt imot flere røykebegrensninger, særlig salgsbegrensninger for sigaretter. Motstanden er noe mindre når det gjelder nye adgangsbegrensninger. Det har aldri tidligere vært målt så stor motstand mot foreslåtte tiltak, noe som kan tyde på at vi vil stå overfor betydelige legitimitets- og håndhevingsutfordringer dersom de mest omstridte tiltakene skulle bli realisert. De tre påfølgende artiklene belyser ulike strategier som røykerne møter denormaliseringspolitikken med. Den første kan beskrives som bevisst å unndra seg en definisjon som røyker. En slik «jeg er egentlig ingen røyker»-tilnærming kjennetegner mange ressurssterke fest- og av-og-til-røykeres selvforståelse. Rikke Iren Tokles studie «Av-og-til-røyking – en dobbeltdistinksjon? Avstand fra både dagligrøyking og streite ikke-røykere» får fram hvordan røyken inngår i det sosiale livet til urbane unge voksne, og hvordan av-og-til-røyking kan sees som uttrykk for motstand mot både avhengighetsperspektivet som assosieres med dagligrøykere og ikke-røykernes helsefokus. I lys av den overordnede ideen om denormalisering av røyking, kan en slik redefinering av røykehandlingen sees som en måte å unndra seg selve dikotomien røyker/ikke-røyker på. I Ola Røed Bilgreis artikkel «Forsvar og motstand: Etablerte røykeres nøytraliserings- og motstandsteknikker i et tobakksfiendtlig samfunn», er det forsvaret for egen atferd og den eksplisitte motstanden mot reguleringer og myndigheter som er i fokus. Forsvaret består av nøytraliseringsteknikker for å nedtone helseplager og risiko, slik at røykingen framstår som mer legitim og rasjonell for den enkelte, mens motstanden innebærer problematisering av restriksjoner som virkemiddel og av hva som egentlig er «god helse». Både forsvar og motstand kan forstås som narrative strategier for å nøytralisere og minke stigmatiseringsfølelser knyttet til røykeatferden. Informantene i Janne Scheffels og Gunnar Sæbøs kapittel «´De andres blikk´: røykernes opplevelse av denormalisering av tobakksbruk», beskriver opplevelsen av å bli sett som røykere gjennom omgivelsenes blikk, både barns og kollegers, men også storsamfunnet og statens «blikk» (via resepsjonen). Mange forteller at de i stor grad kjenner på følelsen av å være devaluert, uten at de nødvendigvis kan referere til konkrete tilfeller av direkte og eksplisitt stigmatisering. Å være en røyker oppleves som en framtredende del av deres sosiale identitet, og når denne i økende grad blir en stigmaidentitet preger dette selvfølelsen deres i dagligdagse situasjoner. I enda større grad enn i Tokles og Bilgreis artikler ser disse røykernes syn på egen atferd ut til å være preget av resignasjon og fatalisme. «Vi blir en sånn utstøtt gruppe til slutt…» 9 I den siste artikkelen analyserer Gunnar Sæbø tobakksbrukernes (inkludert tidligere brukere) syn på seg selv og hverandre, i lys av et sosialt identitetsperspektiv. Analysen viser at norske tobakksbrukere ikke skiller skarpt mellom typiske brukere av ulike tobakksprodukter, idet de underliggende typifiseringene «positiv», «kulturelt marginal» og «lite attraktiv» like gjerne knyttes til både pipe-, sigar-, sigarett- og snusbrukere. Det er altså ikke særegne identiteter knyttet til de ulike produktene. De som selv bruker et bestemt tobakksprodukt betrakter imidlertid en typisk tobakksbruker fra egen gruppe som mer «positiv» og mindre «kulturelt marginal» og «uattraktiv» enn tidligere brukere gjør, noe som indikerer at eksrøykerne har mer negative (og potensielt mer stigmatiserende) stereotypier av røykere. Avslutningsvis diskuteres bruk av stigmatisering som et virkemiddel i folkehelsepolitikk. Det tas også til orde for en nøyere kartlegging av utbredelsen av opplevd stigmatisering blant røykere samt studier av de mulige ulike effektene av stigmatisering på både individ- og populasjonsnivå.
... Although tobacco smoking is legal in Australia, the decline in prevalence combined with the denormalisation of smoking and societal aversion has fated the behaviour to be predominantly relocated to the fringes of society and viewed as a deviant and marginalised behaviour [58]. For some smokers in this study, feeling stigmatised for being a tobacco smoker was the catalyst for them to redefine themselves as 'vapers', as supported by findings from Barbeau and Burda [16], making the language used (i.e. ...
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Background Vaping is a relatively new practice, and therefore its symbolic meanings and social practices are yet to be fully understood, especially within Australia where the practice is strictly regulated. This study aimed to examine vapers motivations for use, reinforcing influences, and association with the vaper subculture. Methods Working from a constructivist epistemology and a symbolic interaction framework, in-depth interviews were conducted with a purposive sample of 37 current (89%) and former (11%) adult vapers, 70% male, mean age of 32.5. Data was analysed via thematic analysis. Results Vapers largely started vaping to quit smoking and underwent common experiences during their initiation phase. Subsequently, vapers tended to adopt one of two dominant identities, that of the ‘cloud chaser’ or the ‘substitute’, which some users moved between during different stages of their vaping career. The social and symbolic meaning of e-cigarettes and vaping varied and involved concepts of harm reduction, addiction, pleasure, stigma and community, and for some, connection to the vaper subculture. Conclusions Understanding the complexities of vaping, and the nuanced differences of ‘cloud chasers’ and ‘substitute’ vapers may have important implications for health communication, research and policy. E-cigarette users within this sample were not a homogeneous group and differed in their motivations for use, association with the vaper subculture and relationship with the vape community. These findings provide new insights into the socialisation process and subsequent identity adoption of vapers within the unique regulatory environment of Western Australia.
... 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]. ...
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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.
... The social acceptability of smoking is declining in many Western countries. 21 Research from Europe suggests that antitobacco information campaigns contribute to lower social acceptability. 22 As anti-tobacco campaigns continue to run in these countries, it may be increasingly difficult to get an accurate self-report from respondents, making biochemical verification a valuable addition. ...
Article
Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type.
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
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Thanks to improvements in living standards and health behavior as well as medical progress since the second half of the twentieth century, old age has become a life phase in its own right. This phase usually begins by the transition from working life to retirement (Kohli, 2000). Both the chance of reaching retirement and the life expectancy after retirement have increased significantly (Eisenmenger & Emmerling, 2011). The post-work phase spans several decades for many people now. In addition, people who retire are considerably healthier and more independent than their peers of earlier birth cohorts (Crimmins, 2004). The expansion of this phase of life has been accompanied by a differentiation of older people in terms of health and independence: healthy and active people experience this phase, as do people in need of help and care. This fact is considered by distinguishing between old and very old people (Baltes, 2007). Characteristics of old age are absence of non-compensable health restrictions, self-determination of various activities (e.g., traveling, hobbies, voluntary work), and strong social integration. Overall, the demands of old age can be coped well in this phase. Very old age is characterized by an increase in physical and cognitive losses and diseases, and a decrease in the abilities and possibilities of compensating for deficits (Baltes, 1997; Baltes & Smith, 2003).
... The social acceptability of smoking is declining in many Western countries. 21 Research from Europe suggests that antitobacco information campaigns contribute to lower social acceptability. 22 As anti-tobacco campaigns continue to run in these countries, it may be increasingly difficult to get an accurate self-report from respondents, making biochemical verification a valuable addition. ...
Article
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Background: Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type. Methods: Using the WHO standardized STEPS methodology, adults self-reported their smoking status. In a later stage of the survey, a subset of participants provided a urine sample, which was tested for cotinine. Using each participant’s objective cotinine measurement and their self reported smoking status, we calculated the sensitivity, specificity and positive predictive value of self-reported smoking. Next, we calculated the estimated prevalence of smokers according to the type of measurement. Results: Results indicated high sensitivity (83.37%, 95% CI: 76.79–88.37%) among males and relatively low sensitivity (38.60% CI: 29.23–48.90%) among females. According to self-report, the prevalence of smokers was 26.44% (23.61–29.48%), while according to cotinine detection, the prevalence of smokers was 32.27% (29.16–35.55%). Among all subgroups, the self-reported prevalence of smoking was significantly lower than the cotinine detected prevalence. Conclusions: To the best of our knowledge, this is the first time that the validity of the STEPS self-reported tobacco indicator has been tested. Self-reported measures of smoking status may lead to an underestimation of smoking prevalence among Georgian adults, especially women. These findings suggest that integration of biochemical measures of smoking into tobacco use studies may be an important investment.
... Une importante littérature anglo-saxonne met en exergue les effets stigmatisants de la lutte contre le tabac, et montre que la dévalorisation d'un comportement (dénormalisation) peut s'accompagner de la dévalorisation des personnes qui adoptent ce comportement (stigmatisation) [12][13][14][15][16]. Selon les sociologues américains Bruce Link et Jo Phelan, le phénomène de stigmatisation s'applique dans les cas où des stéréotypes et appréciations négatives sont observés, et que se produit, dans le cadre d'une relation de pouvoir, un processus de distanciation sociale et de discrimination [17]. En Australie [18], au Canada [19], aux États-Unis [20] et en France [8], il a été montré que les fumeurs sont appréhendés comme des personnes malodorantes, égoïstes, irresponsables ou dangereuses pour elles-mêmes et pour leur entourage. Elles sont également susceptibles de faire l'objet de discriminations en matière d'accès aux soins [21] ou dans le secteur de l'emploi et des assurances [22][23][24][25]. ...
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Tobacco control strategies, considered legitimate and effective, are rarely the subject of critical analysis in France. This is specifically true with regard to their potentially harmful effects, particularly against people who continue to smoke. This article introduces this debate, focusing on the potentially stigmatizing effects of anti-smoking policies. It has been attested by numerous international studies, and by a study in France, that the general process of tobacco denormalization has led to the stigmatization of smokers who then may be subject to discrimination. To the extent that smoking is now concentrated in the most disadvantaged socio-economic populations in France, the latter are thus more exposed to stigma. While underscoring the need to develop targeted interventions against them, this article also warns and calls for vigilance regarding the potential iatrogenic effects of these interventions. It is therefore necessary to develop research and evaluations on this subject in order to accurately measure the effects of these interventions, particularly in terms of stigmatization and self-stigma, and to ensure that public health actors do not generate more problems than they solve.
... [43][44][45] Many tobacco control policies are presumed to reduce tobacco consumption by 'denormalising' tobacco use, making it socially unacceptable. 46 Measures of social norms about tobacco tend to be either descriptive (ie, the prevalence of the behaviour among identity group members) or injunctive (ie, how identity group members believe one should behave). 47 48 A literature review was conducted to determine the most frequently used measures in each of these domains and collect evidence of their reliability and validity. ...
Article
Objective: A Working Group (WG) of tobacco regulatory science experts identified measures for the tobacco environment domain. Methods: This article describes the methods by which measures were identified, selected, approved and placed in the PhenX Toolkit. Findings: The WG identified 20 initial elements relevant to tobacco regulatory science and determined whether they were already in the PhenX Toolkit or whether novel or improved measures existed. In addition to the 10 complementary measures already in the Toolkit, the WG recommended 13 additional measures: aided and confirmed awareness of televised antitobacco advertising, interpersonal communication about tobacco advertising, media use, perceived effectiveness of antitobacco advertising, exposure to smoking on television and in the movies, social norms about tobacco (for adults and for youth), worksite policies, youth cigarette purchase behaviours and experiences, compliance with cigarette packaging and labelling policies, local and state tobacco control public policies, and neighbourhood-level racial/ethnic composition. Supplemental measures included youth social capital and compliance with smoke-free air laws and with point of sale and internet tobacco marketing restrictions. Gaps were identified in the areas of policy environment (public and private), communications environment, community environment and social environment (ie, the norms/acceptability of tobacco use). Conclusions: Consistent use of these tobacco environment measures will enhance rigor and reproducability of tobacco research.
... 61 Within the context of English public health law and policy, long-game approaches are attractive to health improvement advocates because their measures generally avoid being brought by laws that prescribe modes of 'healthy living' using coercion in the formal sense presented above: 62 'denormalization' and 'renormalization' are key aspects of changing attitudes and behaviours, and are achieved in the main through individually noncoercive measures. 63 Anti-tobacco policy provides a clear public health goalreduce and eventually eradicate smoking -that could not be satisfactorily and effectively achieved overnight. Evolving tobacco regulation from successive Westminster governments (as elsewhere) is directing this general, goal-based agenda, but through incremental developments, with continued resistance to hard paternalism. ...
Article
Contemporary public health advocacy promotes a ‘fifth wave of public health’: a ‘cultural’ shift wherein the public's health becomes recognized as a common good, to be realized through concerted developments in the institutional, social, and physical environments. With reference to examples from anti‐tobacco policy, in this article I critically examine the fifth‐wave agenda in England. I explore it as an approach that, in the face of liberal individualism, works through a ‘long‐game’ method of progressive social change. Given the political context, and a predominant concern with narrow understandings of legal coercion, I explain how efforts are made to apply what are presented as less ethically contentious framings of regulatory methods, such as are provided by ‘libertarian paternalism’ (‘nudge theory’). I argue that these fail as measures of legitimacy for long‐game regulation: the philosophical foundations of public health laws require a greater – and more obviously contestable, but also more ambitious – critical depth.
... As the author notes, decriminalisation alone is unlikely to eradicate stigma [10]. Indeed Australian tobacco control regulatory frameworks, which prohibit advertising and restrict sales through taxation and plain packaging and restrict areas where smoking is allowed, have been accompanied by education and media efforts to increase public awareness of health risks and decrease tolerance of exposure to tobacco smoke in order to reduce the social acceptability of smoking [13,14]. ...
... Det har for eksempel blitt publisert flere studier de siste årene som viser hvordan røykere føler seg negativt stemplet Stuber m fl, 2008; McCool m fl, 2012) og utestengt fra stadig flere sosiale arenaer (Bell m fl, 2010). I mange av studiene stilles det spørsmål om det kan vaere slik at selv om et normklima som er negativt til røyking trolig stimulerer mange til røykeslutt, kan det også produsere en følelse av mislykkethet samt økt motstand blant dem som ikke lykkes Chapman & Freeman, 2008;Stuber m fl, 2009;Greaves m fl, 2010)? Til nå har det i liten grad blitt gjort norske studier som fokuserer på slike problemstillinger. ...
... The available data demonstrate that about one quarter of the world's adult population currently smokes, and several million people become fatally addicted every year (2)(3)(4). Most documented successes in reducing tobacco use have occurred in developed countries by effective tobacco control policies (5,6). In contrast, most of the developing countries require more efforts to reach a comparable level. ...
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The relationship between school policies and students' tobacco use is ambiguous, and little is known about low- and middle-income countries. This study was designed to assess the existence of schools' smoking policies, students' exposure to residential smoking, and their relationships with Health Science students' (HSS) tobacco use (cigarettes smoking, shisha use, tombak-dipping and tobacco use on school premises). A cross-sectional survey was carried out using a modified self-reported questionnaire, originally developed by WHO, among a representative sample of 1,590 third-year HSS from 25 schools drawn from 13 universities, with probability proportional to enrollment of schools and third-year students, using three-stages sampling techniques. The response rate was 100% for schools and 68% for students. A multilevel analysis was performed by nesting student-level in school-level variables. Results from the adjusted models revealed that, when students reported awareness of smoking restriction, they were more likely to be current smokers (OR = 2.91; 95% CI: 1.68 to 5.02; p = 0.021) and shisha users (OR = 2.17; 95% CI: 1.54 to 3.06; p = 0.021). Results from additional analysis performed among tobacco users only, showed increased risk of smokers and tombak dippers who smoked or dipped on school premises (OR = 2.38; 95% CI: 1.34–4.25; p = 0.003, OR = 2.60; 95% CI: 1.22 to 5.56; p = 0.013, respectively). Current smokers (OR = 3.12; 95% CI: 1.98 to 4.92; p ≤ 0.001), ever smokers (OR = 1.66; 95% CI: 1.31 to 2.10 p ≤ 0.001) and shisha users (OR = 1.73; 95% CI: 1.36 to 2.21; p ≤ 0.001) were exposed to residential smoking on one or more days during the previous 7 days. High percentages of those who used any kind of tobacco products reported being aware of school smoking policies, indicating no clear evidence that school smoking policies had an impact on use of any of the mentioned tobacco products. The lack of compliance with school policies shows the need for further policy enforcement and sustainability, taking into account the effect of residential smoking and social influences.
... Understanding this process of normalisation is critical both for policy makers and health professionals as it suggests that marketing reduced sugar consumption as 'normal' could have an impact on consumption. Similar efforts have been previously applied in the context of cigarette smoking to de-normalise smoking over time (Chapman & Freeman, 2008). Our study has demonstrated a strong and deeply embedded link between morality and sugar consumption. ...
Article
This study analyses the relationship between food choices and morality by exploring how Australian adults conceptualise and negotiate their sugar intake. Fifteen in-depth, semi-structured interviews were conducted with English speaking adults residing in South Australia. Participants were purposively sampled from a national survey based on their sugar consumption levels, age and gender. The data were analysed using thematic analysis. Participants initially defined sugars as good or bad based on source, colour, texture, taste and impact of sugar on health. On being provided with evidence on amounts of sugar present in commonly consumed foods and drinks, participants redefined their perceptions to consider all sugars as bad sugars. This created moral challenges for the participants leading to two types of justifications for their own sugar consumption. One group of justifications drew on socially evaluative statements that participants used to present themselves as morally virtuous. Here sugar was considered as an essential source of energy and part of a balanced diet; limited to infrequent occasions such as celebrations, social gatherings and cultural practices; and as a cultural obligation. The second group of justifications located the source of morality within the individual and presented sugar intake as important for emotional and psychological wellbeing, and also as something that could be controlled by taking responsibility. There were no differences in discourses between low and high sugar consumers. This study provides new insights on how Australians conceptualise sugar in diet and make consumption decisions, which are important for influencing sugar consumption at a societal level.
... [5][6][7][8][9]43 However, adult smoking prevalence has decreased from 2002 to 2015 alongside increasingly comprehensive policies in all four ITC 4C countries. 18 This may question whether smoking denormalization is a valid approach to tobacco control, or at least that smoker's social norms may be less related to smoking policies and prevalence rates than theorized; 10,11,44 this reflects findings for injunctive norms from a recent ITC study in Europe. 25 Despite this, Kasza et al. 19 found that reporting societal disapproval as a reason to quit smoking increased the odds of making a quit attempt. ...
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Objective: To assess trends in daily smokers' social norms and opinions of smoking between 2002 and 2015 in Canada, US, UK and Australia. Method: Data were from Waves-1 (2002) to -9 (2013-2015) of the longitudinal International Tobacco Control Four Country Survey (Canada, US, UK, Australia), involving 23,831 adult daily smokers. Generalised estimating equation logistic regression models, adjusted for demographics and survey design effects, assessed associations of Wave and country with outcomes: (i) over half of five closest friends smoke, (ii) agreeing that people important to you believe you should not smoke, (iii) agreeing that society disapproves of smoking, and (iv) negative opinion of smoking. Results: Between 2002 and 2015, adjusting for covariates, (i) over half of five closest friends smoke did not change (56% vs. 55%; Adjusted Odds Ratio [AOR]=0.95[95% Confidence Interval=0.85-1.07]), (ii) agreeing that people important to you believe you should not smoke generally decreased (89% vs. 82%; AOR=0.54[0.46-0.64]) despite an increase around 2006-2007, (iii) agreeing that society disapproves of smoking increased between 2002 and 2006-2007 (83% vs. 87%; AOR=1.38[1.24-1.54]) then decreased until 2013-2015 (78%; AOR=0.74[0.63-0.88]), and (iv) negative opinion of smoking decreased between 2002 and 2010-2011 (54% vs. 49%; AOR=0.83[0.75-0.91]) despite an increase around 2005-2006 and at the final Wave (2013-2015). Except friend smoking, Canada had the greatest, and UK the lowest, anti-smoking social norms and opinions. Conclusions: Except friend smoking and opinion of smoking, daily smokers' social norms became less anti-smoking between 2002 and 2015 despite increases around 2006-2007. Several potential explanations are discussed yet remain undetermined. Implications: Increasingly comprehensive tobacco control policies alongside decreasing smoking prevalence in Canada, the US, the UK, and Australia have led to the assumption that smoking has become increasingly denormalised in these countries. Absent from the literature is any formal assessment of social norms towards smoking over time. Contrary to our hypotheses, this study found that the injunctive social norms of daily smokers became less anti-smoking between 2002 and 2015, despite increases around 2006-2007. There was no change over time in the proportion of daily smokers who report that over half of their five closest friends smoke.
... It was hypothesized that among children in their second year of secondary school consuming alcohol in the past month before the survey there would be a difference of 28% in the intervention group compared to the control group, basing this hypothesis on a systematic review [34]. Furthermore, the calculation of the numbers was estimated on the assumption that the proportion of drinkers in the past month in their second year of secondary school would be 14% among subjects assigned to the control group, whereas the percentage would be 10% in the intervention group, i.e., an expected gain of 28%. ...
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Alcohol and tobacco use is a major health problem and one of the first causes of the burden of disease and mortality. School-based alcohol and tobacco use prevention programmes that have demonstrated efficacy are most often based on psychosocial skill development, individuals’ experiential learning strategies, and community resources. Furthermore, early and prolonged interventions have been recommended. Primavera is a pluri-annual, generic, multimodal, experiential-oriented prevention program. It runs over a three-year period from the last year of primary school to the second year of secondary school. This randomized controlled cluster study aimed at assessing the effects of the Primavera programme compared to a control prevention intervention among schoolchildren from 10 to 12 years in eight secondary schools in a particular French geographical area. The primary outcomes were lifetime tobacco use and past-month alcohol use. Data were collected at baseline and over three follow-up time points. In all, 287 and 266 questionnaires, respectively, were collected at baseline from the Primavera group and from the control group. Attrition was 45% and 41%, respectively. The SARS-COV2 pandemic crisis made it impossible for questionnaires to be collected during the final year. After adjustment, children from the Primavera group were less likely to report current alcohol use at the end of the first year (odds ratio = 0.39, 95% CI: 0.18–0.78) and past-month alcohol use at the end of the second year (odds ratio = 0.07, 95% CI: 0.01–0.66) compared to those from the control group. The results for psychosocial skills and alcohol and tobacco use denormalization were contrasted. Primavera is shown to be effective in reducing alcohol use among schoolchildren.
... Exposure to SHS in vehicles is correlated with future smoke initiation (primary prevention relevance) among youth and adolescents [1]. Exposure to SHS at public, outdoor places (e.g., at parks, bus stops, playgrounds, sport and recreational facilities) may be less harmful and toxic with regard to adverse health outcomes, but exposure to, and visibility of, smoking is linked to the societal degree of tobacco "de-normalisation" [10] and the establishment of public role models for children and adolescents [11], as well as to positive beliefs about and public acceptance of smoking [12,13]. Public acceptance of smoke-free regulations varies substantially across settings [14,15], with regulations for non-smoking indoors and in the presence of minors ("child frame" [16]) reaching the highest support rates, while regulations for public, outdoor or adult settings (e.g., parks, outdoor workplaces, public outdoor events) are more contested and receive less support [13,14,17]. ...
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Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in vehicles, indoor, and outdoor settings in the German population, using current data from a representative household survey. We used cross-sectional data (N = 3928 respondents aged 14–99 years) from two waves of the DEBRA survey (German Study on Tobacco Use), conducted between January and March 2020. The reported prevalence of SHS exposure during the last seven days was 19% in vehicles, 25% in indoor settings, and 43% in outdoor settings. We found that younger age and current smoking were consistently associated with higher SHS exposure. Furthermore, people with low education were more likely to be exposed to SHS in vehicles and indoor settings than people with high education. This study found that the prevalence of SHS exposure in vehicles, indoor, and outdoor settings is a relevant feature of everyday life in Germany, especially for younger people and people with lower education, leading to potentially persistent socioeconomic and tobacco-attributable inequalities in morbidity and mortality.
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
... Provided, of course, that legislation does not remain on paper. In our case, implementation of the smoke-free law might de-normalise smoking (i.e., push it out of the sphere of what is considered normal and into being an abnormal practice; Chapman & Freeman, 2008). In time, people may thus develop new habits around smoking and next generations may participate in communities of practice where people's behaviour, more in line with legislation, will promote a different learning. ...
Article
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This paper is about Greek university students’ violation of the smoking law in public venues and their understanding of rights, duties and responsibilities. Thirty-one students (21 smokers) were interviewed and asked to describe and discuss their own and other students’ behaviour in relation to smoking in closed public places in terms of rights and duties. Additional material from the printed and electronic press has been used to provide a context to the students’ statements. Participant-smokers’ systematic violations of the smoke-free law spring from a peculiar view of rights, duties and responsibilities. Both behaviour and its theoretical underpinnings are reinforced in the context of the students’ leisure time “community of practice.” All those involved, that is, cafe owners/staff, customers and law-enforcers, contribute to encouraging smoking by rewarding those who violate the law and discouraging law-abiding behaviours. The authorities in charge usually avoid monitoring public venues for transgressions, which reduces to a minimum the danger of being caught and sanctioned. Cafe owners/staff tolerate smoking, which is interpreted as informal permission. Smokers invoke both customers’ behaviour and the staff’s tolerance as a justification for their own violations of the law. The paper ends with considerations about the status of school knowledge: somewhat weak if compared to the compelling authority of the informal knowledge people acquire in everyday interactions.
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
Chapter
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“Tell me how much your friends earn and I’ll tell you whether you smoke, what diseases you have and how old you’re going to become!” Part of this statement should be familiar to those who are interested in the connection between social inequality and health. People of comparatively lower socioeconomic status are at higher risk of health problems and are more likely to fall ill and die earlier than those who have a higher income etc. However, the sentence does not ask about your own income, but about the income of your friends. Is this information really meaningful? Does it really make a difference to your own health which friends you have, who you surround yourself with in your everyday life and what social position these people have?
... The combined knowledge and perception that smoking is a harmful activity not only to oneself but also to others and the vast reduction in spaces where smoking is still allowed have led to a denormalization of smoking as a tolerated and acceptable activity. Smokers have come to be seen as having a "spoiled identity" (Chapman and Freeman 2008). The Canadian province of British Columbia was one of the first jurisdictions to adopt smoke-free air policies that led to the denormalization of consuming inhalable products in various types of spaces (Bell et al. 2010). ...
Article
The legalization of cannabis has necessitated a debate about the specific public or private places in which the consumption of cannabis should be lawfully allowed. Relevant federal, and state or provincial, laws governing the public consumption of cannabis as of April 2020 were retrieved through primary legal research in LexisNexis and official government websites. Across various states and provinces within the United States and Canada, three types of cannabis-related regulatory regimes have emerged. Quebec has adopted the most restrictive type of regulatory framework. Quebec generally prohibits the smoking or vaping of cannabis in both indoor and outdoor public places, by extending the restrictions on the use of tobacco and alcohol products to cannabis consumption. Slightly less restrictive are jurisdictions such as Ontario and British Columbia, which allow cannabis consumption in most outdoor public spaces, such as streets or parks. Certain local-level jurisdictions within the US states of California and Colorado have adopted the least restrictive local-level regulatory regime, by authorizing the operation of indoor cannabis consumption sites at certain fixed locations or within mobile spaces. The degree to which private consumption is allowed or prohibited also varies widely. An individual who lives or works in a jurisdiction such as Quebec that has prohibited the smoking or vaping of cannabis in almost all public places will be left with limited spaces in which to consume inhalable cannabis products. By contrast, a non-medical cannabis user who lives in Colorado, which authorizes on-site consumption at certain licensed establishments, has far more options to consume inhalable cannabis outside of the home. In this article, we will examine a range of federal-, state- or provincial-, and local-level laws that regulate cannabis consumption in certain public and private places and consider some of the potential public health and safety implications of these laws.
... Tobacco sales in Canada and the USA have stagnated. 1 2 Although denormalisation strategies have reframed smoking (and smokers) as socially unacceptable, [3][4][5][6] these attitudes appear to apply uniquely to smoked tobacco. Cannabis now represents notable opportunities for tobacco companies, with recreational cannabis becoming legalised federally in Canada (effective October 2018) and increasingly at the state level in the USA. ...
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
Chapter
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The loss of employment is an event that interferes with the lives of everyone affected, causes stress, and can have a negative impact on their health. Meta-analyses show that unemployed people have a worse state of health and a mortality risk that is at least 1.6 times higher than those who are employed. Unemployment is associated with a lower mental and physical health status and, in some cases, with riskier health behavior (particularly tobacco consumption). There are two important theses on the role of social networks in this context: (1) Unemployment changes social networks so that they no longer fulfill their positive function for health (mediator thesis); (2) Unemployment leaves social networks unchanged and persons with resource-rich networks suffer less from health losses due to unemployment (moderator thesis). This article provides an overview of empirical analyses on the topic of networks and unemployment.
... Older PCPs reported witnessing a shift in the general French population's depiction of tobacco smokers. While in the past, smoking connoted a range of mostly positive and desirable attributes, thus being a widely accepted behavior, exponential escalation of news about tobacco adverse health effects has led tobacco smoking to become routinely depicted in everyday discourse and media representations in a variety of overwhelmingly negative ways [36,37]. This strong shift toward tobacco smoking denormalization was reported as being helpful by all PCPs in their smoking cessationcounseling role. ...
Article
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Background Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers. Methods A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size. Results A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resources and the treatment and intervention they prescribed (e.g. nicotine replacement therapy, supporting therapist). Conclusions This study provides a better understanding of the beliefs, attitudes, and behaviors of PCPs in managing smoking cessation. Guiding and encouraging patients toward smoking cessation remains a major objective of PCPs. While PCPs reported that progress has been made in recent years in terms of tools, technology and general awareness, they still face major barriers, some of which could be overcome by appropriate training.
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
Chapter
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The influence and significance of social networks in health research are becoming widely discussed. Sociological network research meets the demand for a stronger consideration of “contexts” or the “environment” that influences health and care. Social networks are conceived as a mediating meso-level, which mediates between social macro-structures (e.g., healthcare systems, institutions, and organizations) and individual (not always) rationally acting actors. This perspective offers the possibility to analyze a variety of psychosocial mechanisms. These mechanisms can influence individual health in different ways, including (health) behavior, psyche, or physiology. In this chapter we present some central theoretical concepts, as well as empirical results, on network effects under the headings of “social support,” “social integration,” “social influence,” and “social contagion.”
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
Chapter
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“Tell me how much your friends earn, and I’ll tell you if you smoke, what diseases you have and how long your life will be!” With this somewhat pointed statement, we wanted to shed light on the empirically well-confirmed connection between social and health inequalities from the perspective of network research at the beginning of this book (see chapter “Social networks and health inequalities: a new perspective for research”). Social networks are understood here as mediating entities at an intermediate or meso-level, whose structure and function mediate between vertical (income, education, occupational status, etc.) as well as horizontal (e.g., age, gender, ethnic origin) inequalities and health inequalities (e.g., life expectancy, morbidity rates). Besides this mediating influence a moderating relationship wherein social networks amplify or diminish vertical and horizontal inequalities seems to be reasonable.
... Those with higher social status, for example, distinguish themselves by largely refraining from smoking. People with lower social status continue to smoke, which is accompanied by an increasing social-normative devaluation, the stigmatization of smoking, and, thus, socially disadvantaged population groups (Bell et al., 2010;Chapman & Freeman, 2008;Reuband, 2014). ...
Chapter
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There are significant differences in morbidity (incidence of disease) and mortality (death rate) between men and women. By puberty, male adolescents are more likely to have health problems. During puberty, girls suffer from chronic and mental illnesses and male adolescents are more likely to suffer from acute and life-threatening diseases. Boys and men have riskier health behavior. The field of research mainly relates to the binarity of the sexes—men and women. Studies on trans and queer persons are rare in this field. Networks have a gender-specific effect on risk behavior. Women provide more and more time-consuming social support, even in case of illness. After widowhood, networks have both negative and positive effects, which are gender-specific.
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Since 1960s school-based surveys also focused on social networks of young people. In comparison with other life stages, the evidence regarding social network research is more advanced for school-aged children. These studies identified that homophile of peer groups in adolescence can be attributed to two mechanisms: the thesis of social influence (young people adapt to health and health behaviour of their friends) and the thesis of selection (adolescents choose their friends according to whether they show the same attitudes and (health) behavior as they do themselves). The existing studies focused especially on substance use (smoking and drinking) but also on physical activity and nutrition and to a lesser extent also on mental health, where both these are relevant. However, for explaining health inequalities the evidence is scarce. This chapter will give an overview of social network research on young people and will give insights into the few existing studies regarding the explanation of health inequalities in adolescence (especially regarding smoking). It will also emphasize the need for further research in explaining health inequalities (beyond tobacco consumption) as well as longitudinal research designs.
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Die soziale Netzwerkforschung ist im Jugendalter vergleichsweise weit fortgeschritten, aufgrund von schulbasierten Surveys die v. a. seit den 1960er Jahren durchgeführt wurden.
Article
Background: Recent analyses of data from the US found that young people were increasingly engaging in cannabis use before alcohol and cigarettes. These shifts are important for public health, but it is not clear whether such trends extend beyond the US. The aim of this study is to examine whether and how the age and sequencing of initiation into alcohol, cannabis and cigarette use has changed in Australia since the early 2000s. Methods: Data came from six waves of the Australian National Drug Strategy Household Survey, spanning 2001-2016. We used data from 18 to 21 year-olds (n = 6849) and examined trends in the age at first use for each of the three substances plus any changes in the order of initiation. Results: The mean age of initiation increased steadily for all three substances (e.g. from 14.9 in 2001 to 16.4 in 2016 for alcohol), while the prevalence of any use declined. There were some changes in ordering of use. For example, in 2001, 62 % of respondents who used both cigarettes and cannabis had first used cigarettes at an earlier age than cannabis, compared with 41 % in 2016. Young people who used both alcohol and cannabis remained more likely to try alcohol before cannabis across the study period. Conclusions: Our results partly replicated US findings, with differences potentially reflecting the substantially different environment around these substances in the US compared to Australia. The age of initiation for alcohol, cigarette and cannabis use in Australia has increased sharply over the past 15 years.
Article
A systematic scoping review of anti-smoking mass media campaign literature provided opportunity to explore how social normative theories and constructs are used to influence smoking cessation. Synthesis of findings was constrained by significant heterogeneity. Nevertheless, the results indicate that a broader conceptualization of social norm is worthy of further exploration. Perceptions of what others think and do contributed in multiple ways to the relationship between anti-smoking messaging and quitting outcomes. Furthermore, integrating research on social norms, social identity and communication may improve understanding of why quitting intentions are enhanced in some circumstances but reactance and counter-arguing responses corresponding to lower quitting intentions occur in others. Integrating a broader theoretical understanding of normative influences into campaign development and evaluation may prove useful in demonstrating the effectiveness of this approach in behaviour change campaigns.
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Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents’ perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain. We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts. One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective.
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While pregnancy smoking stigma is widely acknowledged, no psychometrically sound tool to measure it exists. This study was designed to build the Pregnant Smoker Stigma Scale - Public Stigma (P3S-PS) for assessing the stigma of pregnancy smoking in the general French population. A total of 342 adults were recruited online to take the P3S-PS and some items (condemnation/rejection, and support for punitive actions) from other scales. Exploratory factor analysis was performed. Measurement invariance was tested according to gender and smoking status. Temporal reliability was checked after two weeks (n = 72). The P3S-PS has 26 items and four dimensions: "derogatory cognitions," "negative emotions and behaviors," "personal distress," and "information provision." All dimensions were correlated (r = .36 to .75) and have good internal consistency (α.>.70), temporal reliability (ICC>.75), and measurement invariance. Validity is exhibited through the P3S-PS's association with condemnation and rejection (r = .32 to .53), support for punitive actions (r = .35 to .65), and presence of pregnant smokers in the close circle (r = -.23 to -.40). The P3S-PS is a promising tool that exhibits good psychometric qualities. This scale will be useful to trigger research regarding the stigma of smoking while pregnant.
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Introduction: Disease burden due to tobacco smoking in Latin America remains very high. The objective of this study was to evaluate potential impact of implementing smoke-free air interventions on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a mathematical model. Methods: We built a probabilistic Montecarlo microsimulation model, considering natural history, direct health system costs and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths, events) and costs. To populate the model, we completed an overview and systematic review of literature. Also, we calibrated the model comparing the predicted disease-specific mortality rates with those coming from local national statistics. Results: With current policies, over 10 years, of 137,121 deaths and 917,210 events could be averted, adding 3.84 million years of healthy life and saving USD 9.2 billion in these seven countries. If countries fully implemented smoke-free air strategies, it would be possible avert nearly 180,000 premature deaths and 1,2 million events, adding 5 million healthy years of life and saving USD 13.1 billion in direct healthcare. Conclusion: Implementing the smoke-free air strategy would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy. Implications: Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds quality evidence on the potential health effects and savings of implementing smoke-free air policies in countries representing almost 80% of the LAC population.
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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.
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Governments increasingly aim for reducing smoking among their populations. Adolescents are an important target group of tobacco control measures, since this group is highly susceptible to influences that may cause smoking initiation. A widespread measure to reduce the number of adolescent smokers are smoke-free school policies (SFSPs) at secondary schools. However, scientific evidence about the effectiveness of SFSPs on adolescent smoking behaviour remains largely inconsistent. Some studies show a decrease, whereas other studies show no change or even an increase in adolescent smoking behaviour. The key reason for this inconsistency is that most studies use methods that were designed for making universal claims about whether and to what extent policies are effective, yet these methods are insufficiently able to take into account the complexity of the school environment. This complexity causes varying effects of SFSPs from individual to individual and from school to school, because their effects strongly depend on how relevant actors respond to the implementation of SFSPs. This dissertation therefore applies an innovative theory-driven method for evaluation, in our case the ‘realist approach’, to develop a better understanding of variations in the effectiveness of SFSPs. Two objective will be addressed: 1. Develop a comprehensive understanding of how, for whom and under which circumstances smoke-free school policies may impact adolescent smoking behaviour. 2. Develop a similar understanding about rule enforcement by school staff members. The dissertation finishes with a set of practical recommendations on how to improve the effectiveness of SFSPs and a reflection on the realist approach.
Article
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.
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Objective: Research has demonstrated that gambling is becoming increasingly normalised for women. As limited research has sought to understand women's perspectives on this issue, we sought women's opinions about the factors that may contribute to the normalisation of gambling for women, and the strategies that may counter this normalisation. Methods: Semi-structured interviews were conducted with 41 women in young and middle adulthood, aged 20-40 years. Results: Participants suggested that gambling was normal for women because gambling environments had been designed to appeal to women, newer technologies had removed the stigma of attending physical venues, and the growing equality and independence of women. To de-normalise gambling, women suggested addressing the influential role of marketing, designing new public education strategies, addressing the availability and accessibility of gambling, and restricting engagement with gambling products. Conclusion: This study highlighted women's perceptions of strategies to address the normalisation of gambling and the importance of providing risk information paired with broader policy reform and prevention initiatives to address the range of determinants that normalise gambling for women. Implications for public health: Involving women in advocacy and understanding their perspectives is important in developing relevant public health responses to the normalisation of gambling for women.
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Background and aims: Social norms towards smoking are a key concept in tobacco control policy and research; however, the influence and strength of different types of social norms on youth smoking uptake is unclear. This study aimed to examine, quantify, and compare evidence of the longitudinal associations between different types of social norms towards smoking and youth smoking uptake (initiation and escalation). Methods: Systematic review searching four databases (MEDLINE/EMBASE/PsycINFO/CINAHL) from January 1998 to October 2020. Evidence synthesis via narrative review, meta-analysis pooling unadjusted associations (initiation only, due to heterogeneity in escalation outcomes), and meta-regression comparing effect-sizes by norm type and study characteristics. Studies included observational prospective cohort studies using survey methodology with youth aged ≤24 years. Measurements included longitudinal associations between descriptive norms (perceived smoking behaviour) and injunctive norms (perceived approval/disapproval of smoking) among social network(s) and subsequent smoking initiation or escalation. Results: Thirty articles were identified. In the narrative review, smoking initiation (but not escalation) was consistently predicted by two norms: parent and close friend smoking. Associations between smoking uptake and other descriptive norms (smoking among: siblings, family/household, partner, peers, adults) and all injunctive norms (perceived approval of smoking among: parents, siblings, close friends/peers, partner, teachers, people important to you, the public) were less consistent/inconclusive. In the meta-analysis pooling unadjusted associations, 17 articles were included (N=27,767). Smoking initiation was predicted by the following descriptive norms: smoking among parents (OR=1.88[95%CI=1.56-2.28]), close friends (OR=2.53[1.99-3.23]), siblings (OR=2.44[1.93-3.08]), family/household (OR=1.55[1.36-1.76]), and adults (OR=1.34[1.02-1.75]), but not peers (OR=1.14[0.92-1.42]). Smoking initiation was also predicted by two injunctive norms, perceived approval of smoking among parents (OR=1.74[1.27-2.38]) and the public (OR=4.57[3.21-6.49]), but not close friends/peers (OR=2.36[0.86-6.53]) or people important to the individual (OR=1.24[0.98-1.58]). Conclusions: In this systematic review (narrative and meta-analysis), descriptive norms of parents' and close friends' smoking behaviour appeared to be consistent predictors of youth smoking initiation, more so than the descriptive norms of more distal social networks and injunctive norms.
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Background and aims: Most studies in English-speaking countries have found a positive association between e-cigarette experimentation and subsequent daily tobacco smoking among adolescents. However, this result may not be valid in other cultural contexts; in addition, few studies have assessed whether this association varies with the subject's age at the time of e-cigarette experimentation. This study aimed to estimate the association between experimenting first with e-cigarette (rather than tobacco) and subsequent daily smoking according to age at the time of experimentation. Design: Secondary analysis; risk-ratios (RRs) computed using modified Poisson regressions with inverse probability weighting. Setting: A cross-sectional nationwide representative survey performed in 2017 in France. Participants: French adolescents (n=24,111), aged 17 to 18.5 years, who had previously experimented with either e-cigarettes or tobacco. Measures: Exposure was defined as the experimentation with e-cigarettes first (whether or not followed by experimentation with tobacco); the outcome as daily tobacco smoking at the time of data collection. Gender, age, literacy, socioeconomic status, pre-exposure repeat school years and experimentation with 12 other licit and illicit drugs were adjusted for. Uncertainties about the sequence of events defining exposure were handled by the definition of three patterns of exposure, to avoid a misclassification bias. Findings: Exposure reduced the risk of transition to daily smoking: RR=0.58, 95%CI=[0.54, 0.62]. This effect increased in linear manner with age at exposure (RR=0.87, 95%CI=[0.78; 0.98] for 1 year, p<0.001): from RR=1.30 95%CI=[1.09; 1.54] at age 9 to RR=0.38, 95%CI=[0.32; 0.45] at age 17. Conclusions: Experimenting with e-cigarettes first (as opposed to tobacco first) appears to be associated with a reduction in the risk of daily tobacco smoking among French adolescent at ages 17-18.5, but this risk varies negatively with age at experimentation, and early e-cigarette experimenters are at higher risk.
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In April 2002 British American Tobacco Australia became the first tobacco company in Australia to be ordered to pay compensation to a person dying of smoking-related illness. In the United States such civil claims have resulted in tobacco companies being ordered to pay massive remedial and punitive damages. While many now accept that tobacco companies may be civilly liable, little attention has been given to their potential criminal liability. This article challenges the false assumptions surrounding the "legality" of the tobacco industry and outlines the case for criminal responsibility. It then concludes with suggestions for reform of the tobacco industry.
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To determine the prevalence and characteristics of smokers who experience smoking-induced deprivation (SID), and to examine its effect on quit attempts, relapse and cessation. Waves 2 and 3 (2003-5) of the International Tobacco Control Policy Evaluation Survey were used, which is a prospective study of a cohort of smokers in the US, Canada, UK and Australia. SID was measured with the question "In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?" A total of 7802 smokers participated in the survey in wave 2, of whom 5408 were also interviewed in wave 3. The proportion of smokers who reported SID was highest in Australia (33%) and lowest in the UK (20%). Younger age, minority status and low income were associated with a higher probability of SID. Some of the other factors related to a higher probability of SID were higher level of nicotine dependence, having an intention to quit, and smoking to help one socialise or control weight. The relationship between SID and quit attempt was mediated by having an intention to quit and worrying that smoking would damage health and reduce the quality of life. The relationship between SID and relapse was mediated by perceived stress. SID was not associated with successful cessation. Many smokers experience deprivation that is the result of their smoking. Strategies to reduce the prevalence of smoking probably effect a general improvement in standards of living and reduction in deprivation.
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For about three decades countries such as Australia, Great Britain, and the United States have been turning up the heat on tobacco advertising. Encouraging, sometimes dramatic falls in consumption have followed. On any given day in 1993 smokers in such countries are exposed to a welter of news, information, persuasion, and policies designed to turn them off smoking. For a long time explanations and evaluations of the effects of these policies and interventions have been tied to oversimplified causal models when the reality is rather more messy and complicated. Four factors largely explain the reluctance of researchers to move beyond these models: the reductionist tradition of science; the explanatory privileging of recent events and factors; pragmatic concern for policy "tractable" factors; and the relation of funding to the evaluative process. Broader research approaches to understanding changes in complex behaviours such as smoking are required--for example, qualitative methods.
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Can you scare people out of smoking? Since Janis and Feshbach’s influential research on the use of fear in dental hygiene education in the early 1950s,1 several generations of health educators have often uncritically accepted as near holy writ that you should not try to scare people into healthy practices, including smoking prevention and cessation.2 3 Given that survey evidence from ex-smokers has repeatedly affirmed that personalised concern about “scary” health consequences is the primary motivation ascribed to smoking cessation4-6 and is associated with predictors of cessation,7 interesting questions arise about whether this dogma is empirically grounded or whether it rather reflects a profession-wide neurosis intent on avoiding opprobrium from those who believe it is somehow not “nice” to deal in gory imagery in the name of persuasion.8 A mass media-led campaign launched in Australia in June 1997 has been seen by many as “the mother of all scare campaigns” (see the illustrations on the cover of this issue of Tobacco Control , the figure in this essay, the campaign-related material on the world wide web at , and the description of that web site on page 89). The television advertising campaign has been described repeatedly as “hard-hitting”, “gory”, and something smokers will “see once and never forget”. It has since been used by the state of Massachusetts tobacco control programme9 with dozens of other international enquiries also having been received. To some, the campaign might be seen as something of a health promotion profanity in the wake of recent so-called “positive” practice—for example, campaigns using every manner of non-smoking role model; general proselytising about “healthy lifestyles”, freshness, and so on). However, to others it represents the culmination of a painstaking formative research process undertaken in the context of a stalled decline …
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This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.
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Against a background of declining tobacco use and generally positive changes in other heart disease risk factors, a systematic review of 14 multiple risk factor intervention trials for preventing coronary heart disease1 concluded that reductions in mortality in the intervention groups were insignificant and changes in risk factors only modest, when compared with the reductions also seen in control groups. The Minnesota Heart Health Program reported similar outcomes2 3 and the major multi-community smoking cessation trial, COMMIT4 5 had a similar modest effect on smoking. Compared with typical community health promotion initiatives which operate on token budgets, all of these interventions were large scale, although still were funded with petty cash when compared with the promotional budgets used by the tobacco industry. Favourable improvements in the secular trend for risk factors such as smoking, and programme contamination of control groups have generally been cited as putative explanations of the lack of difference between intervention and control groups, with media leakage—being the most uncontrollable factor—deemed responsible.6 Doubtless, some of this leakage involved news coverage of specific interventions intended only for the eyes and ears of the experimental populations. However it is myopic to assume that it is only discrete efforts orchestrated by health agencies leaking into control areas which, in aggregate, constitute the possible forces generating positive secular trends in the wider population. In a recent issue of Tobacco Control , Melanie Wakefield and Frank Chaloupka called for more attention to the description and quantification of tobacco control “inputs”.7 They noted that the preoccupation with outcomes in evaluation research is often accompanied by overly casual accounts of the policy and intervention variables that are assumed to be the causative factors potentially producing change. In their editorial they argued for the further development of a range of …
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To assess public perceptions of the tobacco industry and behavioural intentions for tobacco use in response to watching the film The Insider. Self administered pre-film survey conducted immediately before viewing and post-film telephone survey conducted within 1-5 weeks of viewing. Two commercial cinemas in Melbourne, Australia. 323 cinema patrons were recruited before screening of target films. 182 watched The Insider, 141 watched Erin Brockovich. Subjects watched one of two films: The Insider which featured information about unethical conduct by the tobacco industry and negative information about the health effects of smoking, or the "control" film Erin Brockovich which had an analogous plot without anti-tobacco content. Pre-film questionnaire: assessed movie viewing habits, demographic characteristics, smoking status, attitudes towards the tobacco industry, intentions for smoking. Post-film questionnaire: assessed same attitudes and intentions plus questions on the film viewed and perceptions of smoking prevalence. 266 (82%) subjects completed the post-film survey. Attitudes toward the tobacco industry were unfavourable at baseline. Those who saw The Insider held more negative views of business conduct by the tobacco industry than those who saw Erin Brockovich, once pre-existing attitudes to the industry were controlled for. The Insider also appears to have promoted a short term reduction in intentions to smoke. Results of this study suggest that if people were recurrently exposed to anti-tobacco content in movies there is potential for a more substantial and lasting impact on attitudes toward the tobacco industry and smoking.
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To assess public attitudes toward the tobacco industry and its products, and to identify predictors of attitudes supportive of tobacco industry denormalisation. Population based, cross sectional survey. Ontario, Canada. Adult population (n = 1607). Eight different facets of tobacco industry denormalisation were assessed. A denormalisation scale was developed to examine predictors of attitudes supportive of tobacco industry denormalisation, using bivariate and multivariate analyses. Attitudes to the eight facets of tobacco industry denormalisation varied widely. More than half of the respondents supported regulating tobacco as a hazardous product, fining the tobacco industry for earnings from underage smoking, and suing tobacco companies for health care costs caused by tobacco. Majorities also thought that the tobacco industry is dishonest and that cigarettes are too dangerous to be sold at all. Fewer than half of the respondents thought that the tobacco industry is mostly or completely responsible for the health problems smokers have because of smoking and that tobacco companies should be sued for taxes lost from smuggling. In particular, less than a quarter thought that the tobacco industry is most responsible for young people starting to smoke. Non-smoking, knowledge about health effects caused by tobacco, and support for the role of government in health promotion were independent predictors of support for tobacco industry denormalisation. Although Ontarians are ambivalent toward tobacco industry denormalisation, they are supportive of some measures. Mass media programmes aimed at increasing support for tobacco industry denormalisation and continued monitoring of public attitudes toward this strategy are needed.
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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.
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Corporate social responsibility (CSR) emerged from a realisation among transnational corporations of the need to account for and redress their adverse impact on society: specifically, on human rights, labour practices, and the environment. Two transnational tobacco companies have recently adopted CSR: Philip Morris, and British American Tobacco. This report explains the origins and theory behind CSR; examines internal company documents from Philip Morris showing the company's deliberations on the matter, and the company's perspective on its own behaviour; and reflects on whether marketing tobacco is antithetical to social responsibility.
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To determine (i) whether people advertising themselves on a dating website were more likely to be smokers than members of the general population; and (ii) whether attractive advertisers (those whose ads were viewed most often) were less likely to smoke than all advertisers. Comparison of the number of advertisers who smoke with survey data on national smoking status. "RSVP", Australia's largest web-based dating site (455,196 members on 12 October 2004). 132,176 advertisements accessed on 10 February 2004. Smoking status; and "votes" for advertisers' attractiveness based on how often visitors to the site accessed individual advertisements. In every age group, there were higher proportions of women smokers among the advertisers than in the general population (P < 0.05), and this was also the case for men aged 50 years and over. There was a higher proportion of non-smokers in the "Top 100" men or women advertisers aged 20-29 years (82%) compared with total RSVP advertisers in this age group (67%) (P < 0.001). 85% of the men and 78% of the women in the two "Top 100" groups were non-smokers, with only 2% of both sexes claiming to be regular smokers. Compared with the general population, a higher proportion of women and older men who advertise themselves on a dating website are smokers. Smokers may be perceived as less attractive.
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The present study attempted to identify predictors of smoking cessation in a cohort of cigarette smokers followed over 13 years. Data are reported on 6,603 persons who resided in one of 20 U.S. communities involved in the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT) study, were current smokers in the COMMIT trial in 1988, and completed detailed tobacco use telephone surveys in 1988, 1993, and 2001. A person was classified as a former smoker if at the time of follow-up he or she reported not smoking for at least 6 months prior to the interview. Reasons and methods for quitting also were assessed in 1993 and 2001. Among smokers in 1988, 24% had stopped smoking by 1993 and 42% were not smoking by 2001. The most frequently cited reasons for quitting were health and cost reasons, while assisted methods to quit were more common in more recent years. Measures of nicotine dependence were much more strongly associated with cessation than measures of motivation. Other predictors included male gender, older age, higher income, and less frequent alcohol consumption, although the gender effect no longer existed when cessation from cigarettes as well as other tobacco products was considered as the outcome. The present study shows that nicotine dependence is a major factor predicting long-term cessation in smokers. This finding has implications for tobacco control policy and treatment approaches.
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The tobacco industry has long denied or played down the risks of smoking, addiction, and passive smoking in Australia.1–3 A survey commissioned by Phillip Morris in 1993 indicated that most Australian opinion leaders and the general public have an unfavourable opinion of the company, even less favourable than that of Americans.4 Faced by a rising tide of litigation, the tobacco industry has attempted to change their image over the past decade to one of a “socially responsible” corporate citizen.5 Unlike in the USA, where the tobacco industry have engaged in extensive corporate image advertising and campaigns directed at youth and parents, in Australia, tobacco companies have focused on …
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To report on prevalence, trends and determinants of smoke-free home policies in smokers' homes in different countries and to estimate the effects of these policies on smoking cessation. Two waves of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a cohort survey of smokers conducted by telephone. Wave 1 was conducted in October/December 2002 with broadly representative samples of over 2000 adult (>or= 18 years) cigarette smokers in each of the following four countries: Canada, the United States, the United Kingdom, and Australia, 75% of whom were followed up at Wave 2 on average seven months later. KEY MEASURES: Levels of smoking restrictions in homes (both waves). Australian smokers were most likely to live in smoke-free homes and UK smokers least likely (34% v 15% at Wave 1). Levels of smoke-free homes increased between waves. Logistic regressions indicated that the main independent predictors of smokers reporting smoke-free homes or implementation of a smoke-free policy between waves included household factors such as having a child, particularly a young child, and having other non-smoking adults in the household. Positive attitudes to smoke-free public places and/or reported presence of smoke-free public places were independent predictors of having or implementing smoke-free homes, supporting a social diffusion model for smoking restrictions. Intentions to quit at Wave 1 and quitting activity between survey waves were associated with implementing bans between Waves 1 and 2. Presence of bans at Wave 1 was associated with significantly greater proportions of quit attempts, and success among those who tried at Wave 2. There was no significant interaction between the predictive models and country. Smoke-free public places seem to stimulate adoption of smoke-free homes, a strategy associated with both increased frequency of quit attempts, and of the success of those attempts.
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In 2005, matches and lighters were struck under an estimated 5.494 trillion cigarettes consumed by the world's 1.3 billion smokers. The great majority of their non-biodegradable butts are thrown on the ground. Butts are easily the single most common form of litter, with one analysis showing they constitute 39% by weight of all litter. For many smokers, the world is their ashtray.
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This 4th edition of the text introducing the Precede-Proceed model provides extensive links (via www.lgreen.net) to the research and theory on which it has built since previous editions. A 5th edition is in progress, featuring new published applications of the model in community, school, and healthcare settings.
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review first the many advantages that stem from the availability of longitudinal data / (a) precision in the timing and measurement of experiences and of forms of behavioural expression; (b) the possibility of studying the process by which a risk variable leads to several different maladaptive outcomes; (c) the subdivision of disorders according to age of onset; (d) the study of change in individual subjects as a result of exposure to some risk variable; and (e) the analysis of indirect causal chain mechanisms explicit statements on the underlying constructs and on the postulated causal processes . . . [are] discussed further in relation to some key problems and issues in using longitudinal data to tackle causal questions / (a) the exclusion of third variable effects . . . ; (b) the need to differentiate risk indicators from risk mechanisms; (c) the choice of sample to highlight risk comparisons; (d) the choice of the most appropriate variable for the causal hypothesis being investigated; (e) the selection of the form of statistical analysis; and (f) the tracing of circular causal processes and of chain effects over time the role of theory types of longitudinal studies (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The tobacco industry recommends "common courtesy" as the solution to potential conflicts over smoking in public places and as an alternative to policies that restrict or ban smoking. Specifically, the industry suggests that nonsmokers "mention annoyances in a pleasant and friendly manner" and that smokers ask others, "Do you mind if I smoke?" We analyzed data for 22 000 adults who responded to the 1987 National Health Interview Survey of Cancer Epidemiology and Control to determine if common courtesy is being used in passive-smoking situations. Almost half (47%) of smokers said they light up inside public places without asking if others mind. When someone lights up a cigarette inside a public place, only 4% of nonsmokers ask the person not to smoke despite the fact that most nonsmokers consider secondhand smoke harmful and annoying. We compared these data with similar data collected by the Roper Organization in the 1970s and found that smokers today are less likely to smoke inside public places. However, nonsmokers' actions in response to secondhand smoke have changed very little. These findings show that the common courtesy approach endorsed by the tobacco industry is unlikely, by itself, to eliminate exposure to environmental tobacco smoke. Though no one would oppose the use of common courtesy, we conclude that legislative or administrative mechanisms are the only effective strategies to eliminate passive smoking. (JAMA. 1990;263:2208-2210)
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This study examines the relationship between smoking cessation and absence from work by analyzing data collected from a large sample of ex-smokers. In particular, it is hypothesized that if smoking cessation is of benefit for work attendance, the incidence of absence should be inversely related to the amount of time elapsed since smoking cessation. A multivariate logit model of absence incidence is proposed which includes variables measuring the amount of time since smoking cessation. This model is then estimated using data collected from a sample of 4,812 ex-smokers as part of the 1989/1990 Australian National Health Survey. The estimated coefficients indicate that the probability of absence among ex-smokers is highest for those who only stopped smoking in the past year and progressively falls with the number of years since smoking cessation, with persons who last smoked at least 20 years ago found up to 4.5 times less likely to be absent from work than persons who ceased smoking during the previous year. Smoking cessation is not only associated with improved health outcomes, but also with improved behavioral outcomes, such as increased work attendance. However, such improvement is observed only over relatively long periods of time.
Article
The purpose of this study was to investigate whether smokers outside buildings with work-place smoking bans smoke "harder" than those smoking in social settings. An unobtrusive random observational study of smokers followed by structured interview was used, with 143 smokers taking smoking breaks outside their office buildings and 113 smokers in social settings. The main outcome measurements were number of puffs per cigarette and cigarette smoking duration. The mean number of puffs per cigarette for the office building group was 18.7% greater than that for the social settings group (10.7 +/- 3.2 vs. 8.7 +/- 2.7, t = 5.58, df = 253, p < 0.001); 74.8% of smokers outside offices took more than the mean number of puffs for the group compared to 42.5% of smokers in social settings (chi 2 df 1 = 26.31, p < 0.0001). Mean cigarette smoking duration was 30.4% shorter for the work-place group than the social settings group (3.9 +/- 1.2 minutes vs. 5.6 +/- 2.6 minutes). Of smokers outside offices, 55.2% had a cigarette smoking duration between 3 and 4.59 minutes, while 53.1% of smokers in social settings took > or = 5 minutes to smoke the observed cigarette (chi 2 df 2 = 31.55, p < 0.0001). Smokers who scored at the 75th percentile on the Fagerstrom Tolerance Scale took a mean 9.5 +/- 2.6 puffs per cigarette compared to 9.3 +/- 2.7 puffs by those who scored in the 25th percentile on the scale (t = 0.34, df = 145, p = 0.73). Regardless of degree of nicotine dependency, smokers leaving work-stations to smoke outside buildings smoked their cigarettes nearly 19% "harder" than cigarettes smoked in social settings. The individual and public health benefits of reduced smoking frequency engendered by work-place smoking bans may be lessened by policies which allow smokers to take smoking breaks.
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To determine community views about the believability and standards of honesty and ethics of tobacco companies, related policy options, and mechanisms for tobacco control funding. A representative population survey of 808 South Australians aged 18 years and older, contacted by telephone, using an electronic white pages sampling frame, with a response rate of 72%. 80% of respondents and 74% of smokers thought tobacco companies mostly did not or never told the truth about smoking and health, children and smoking and addictiveness of tobacco. With regard to perceived standards of honesty and ethics, tobacco company executives were rated the lowest of all professional groups, with 74% of respondents judging them to have low or very low standards. 89% of smokers would support full product information on the pack about chemicals and additives in cigarettes. 77% thought shopkeepers should pay back the amount they gain from children smoking cigarettes and 80% thought tobacco companies should do so, or be fined or taxed accordingly. 53% agreed the government should spend an amount equal to the amount gained from children's smoking and 21% indicated a higher expenditure. Tobacco companies are held in low regard by the public and by smokers who are their customers. There is a high degree of support for tobacco control efforts to be financed by being indexed to the level of children's smoking in the community, through the amount made by shopkeepers, manufacturers and the government from children's cigarette consumption.
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To review the principal sub-texts contained in all press coverage and references to the tobacco industry in a major Sydney newspaper over five years. METHOD AND SAMPLE: After excluding value-neutral financial page reports, thematic analysis of all value-laden references to the tobacco industry in the Sydney Morning Herald, January 1993 to December 1997. Some 155 articles containing 221 separate references to the tobacco industry were identified. Eight sub-texts (callous merchants of death; conspiracy/cover-up; blood money; toxic pied pipers; corporate leviathans; beleaguered/legitimate industry; index case of unethical or corrupt practice; and bumbling fools) accounted for all 221 references. Eighty-nine per cent of references to the industry framed it negatively. Journalists or regular newspaper columnists authored 56% of the references. Only 5% of comments were attributed to tobacco company sources. In press reports, the tobacco industry is routinely framed as a corporate pariah by journalists, the public, government spokespeople and tobacco control advocates. Routine negative publicity about the tobacco industry is likely to significantly reduce its public credibility and political influence.
Article
Public sentiment in the United States has been evolving against cigarette smoking. Providing support for stronger tobacco control legislation, unfavorable public sentiment has contributed to the decrease in the size of the smoking population in this country. The present study hypothesizes that the unfavorable public sentiment may also discourage cigarette smoking by creating an unfavorable "smoking climate" in which smoking is socially rejected as a deviant behavior. Analyses of several secondary data-sets provided evidence that smoking rates are lower in the states where the public holds relatively unfavorable sentiment toward cigarette smoking. The relationship between public sentiment and smoking rates was significant even after controlling for the effects of state-level tobacco control measures, such as cigarette taxes and smoking restrictions in private workplaces and restaurants. We also found that smokers who have experienced unfavorable public sentiment are more willing to quit smoking than those who have not, supporting the hypothesized effects of antismoking public sentiment on smoking behaviors.
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Public health advocacy is the strategic use of news media to advance a public policy initiative, often in the face of opposition.
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The tobacco industry continues to seek corporate "respectability", despite being responsible for the deaths of millions of smokers worldwide every year.
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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?
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Demarketing (i.e., the act of discouraging consumption or use [of specific products or services]) of cigarettes has been a public policy objective for the past 40 years or more. The use of demarketing actions, such as antismoking advertising campaigns, has contributed to the decrease of the proportion of smokers in the general population. A consequence of demarketing efforts has been the development of negative stereotypes of smokers. The author investigated whether the negative stereotypes that are directed at smokers can be transferred by observers to services that the smokers use. The results of the scenario-based experiment indicated that participants who had read narrative descriptions of a customer had expectations of service atmospherics (physical characteristics, e.g., cleanliness, odors) that were more negative when associated with a smoker target than when associated with a nonsmoker target.