Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care

doi:10.1001/journalofethics.2017.19.5.msoc1-1705

Cited by 71 publications

(36 citation statements)

References 31 publications

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“…Creators of public health interventions need to consider the ethical implications of the interventions they endorse. Similar arguments have been made in the context of anti-smoking campaigns and the promotion of lung cancer stigma, with some suggesting that creators of interventions are ethically responsible for minimizing the stigmatizing impact of the campaigns that they promote (33). Indeed, there is evidence that anti-smoking campaigns have increased the stigmatization of smoking (34) and while some have argued that this has increased their effectiveness (34), others have provided evidence of unintended negative consequences for smokers who have internalized this stigma (35).…”

Section: Public Policy Implicationsmentioning

confidence: 69%

Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma?

Hayward

Vartanian

2019

Obesity Science & Practice

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Summary Introduction Public health interventions need to balance the benefits with any potential harms. One proposed intervention for reducing sugar‐sweetened beverage consumption involves placing graphic warning labels on products and advertisements. A recent study found that a graphic warning label that contained negative imagery of obesity reduced purchases of sugar‐sweetened beverages. However, these labels may also promote obesity stigma, which is concerning given that weight stigma is associated with harmful health consequences including weight gain and increased risk of mortality. Methods In Study 1 ( n = 681), participants viewed a standard soda label or the graphic warning label online and then completed measures of disgust and prejudice towards people with obesity. In Study 2 ( n = 506), participants who identified as having overweight or obesity viewed the graphic warning label online before or after completing measures of mood and state self‐esteem. Results In Study 1, participants who had viewed the graphic warning label reported higher disgust and weight bias. In Study 2, the majority of participants perceived the warning label to be stigmatizing, and participants displayed worse mood and, through this, lower self‐esteem after viewing the label. Conclusions Although the graphic warning label has been found to reduce sugary drink purchases, it also promotes obesity stigma and is perceived as stigmatizing by individuals with overweight and obesity. Given that weight stigma predicts harmful health and well‐being consequences, the benefits of graphic warning labels need to be balanced against the potential costs.

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Section: Public Policy Implicationsmentioning

confidence: 69%

Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma?

Hayward

Vartanian

2019

Obesity Science & Practice

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“…Beyond acceptability, another important factor to consider is the potential for HWLs to lead to unintended consequences, such as weight stigma, which can have a negative impact on health ( Tomiyama et al, 2018 ). Research indicates that HWLs on SSBs can increase stigma ( Hayward & Vartanian, 2019 ) and similar associations between stigma and ‘hard-hitting’ smoking campaigns have also been shown for those with smoking-related illnesses ( Riley, Ulrich, Hamann, & Ostroff, 2017 ). Although the HWLs were designed in line with relevant guidance, further recommendations to minimise potential stigma include providing messages with counter-stigma themes alongside HWL messages ( Hayward & Vartanian, 2019 ), i.e.…”

Section: Discussionmentioning

confidence: 83%

Impact of health warning labels on snack selection: An online experimental study

et al. 2020

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Excessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. In a between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design, participants (N = 4134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task. The proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (no label: 59%; calories only: 54%; text-only HWL: 48%; text-only HWL with calories: 44%; image-and-text HWL: 37%; image-and-text HWL with calories: 38%). Compared to the no label group, participants were least likely to select an energy-dense snack in the image-and-text HWL group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001). Health warning labels – particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.

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“…Varenicline's primary side effects, such as nausea, may exacerbate side effects that cancer patients experience, which reduce medication compliance ( Roeland, Aapro, & Schwartzberg, 2015 ). Moreover, given the stigma associated with smoking after a cancer diagnosis ( Riley, Ulrich, Hamann, & Ostroff, 2017 ), patients may be more likely to overstate their level of adherence to medication. Alternatively, to the extent that cancer patients are more motivated to quit smoking, they may be more adherent to medication.…”

Section: Introductionmentioning

confidence: 99%

The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence

Crawford

Jao

Peng

et al. 2018

Addictive Behaviors Reports

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IntroductionThe degree to which smokers quit successfully with varenicline is strongly associated with their adherence to the medication regimen. Thus, measuring varenicline adherence to identify smokers needing additional intervention is a priority. Few studies, however, have examined the validity of self-reported varenicline adherence, using a biological assessment of adherence as a reference. No study has examined this issue among cancer patients trying to quit smoking, who may show unique patterns of adherence given their medical comorbidity.MethodsThis study used data from 76 cancer patients who received varenicline and provided self-reported varenicline adherence data (pill count) and a blood sample to determine varenicline metabolites 4 weeks after initiating varenicline.ResultsReceiver operating characteristic (ROC) curve analyses of plasma varenicline levels showed that 4 ng/ml was the optimal cut-point for differentiating adherence with significant (p's < 0.04) area under the curve values, ranging from 0.73–0.80 for 3-day, 7-day, and 4-week self-reported pill count; specificity values ranged from 0.63–0.78 and sensitivity values ranged from 0.82–0.94. Using this cut-point, adherence was high (88%). However, plasma varenicline levels were weakly correlated with 3-day and 4-week pill count and total pill count (12 weeks) was not correlated with plasma varenicline levels. Patients with head and neck cancer, gastrointestinal cancer, and more advanced disease showed lower varenicline adherence and lower plasma varenicline.ConclusionsUsing the 4 ng/ml cut-point, this study suggests validity of short-term self-reported varenicline adherence among cancer patients undergoing tobacco dependence treatment in contrast to studies in the general population, which supported 12-week pill count.

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Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care

Cited by 71 publications

References 31 publications

Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma?

Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma?

Impact of health warning labels on snack selection: An online experimental study

The association between self-reported varenicline adherence and varenicline blood levels in a sample of cancer patients receiving treatment for tobacco dependence

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