Differential access to health care and support? A qualitative analysis of how Australian smokers conceptualise and respond to stigma

Abstract

Scholarship on stigma, originally theorised as a 'mark' of social disgrace or difference, has since moved away from individual-level analyses to consider the socio-cultural context in the 'marking' of groups of people. In response to this theoretical shift, scholars have demonstrated how extensive tobacco denormalisation policies have contributed to the stigmatisation of smokers, documenting smokers' experiences of stigma across a number of developed countries.We extend this analysis to the Australian context, examining smokers' constructions of stigma and their reactions to policies that would give smokers differential access to healthcare. Based on 29 interviews with Australian smokers, we focus on what constitutes evidence of stigma and how participants' use social comparisons to respond to stigma. We then explore an assumption underpinning participants' accounts of stigma: that only smokers committed to cessation are 'deserving' of treatment. We close by discussing theoretical perspectives and opportunities in stigma research and the need to extend a stigma lens to study emerging public health issues, such as electronic cigarettes.

Smokers’ Understandings of Addiction to Nicotine and Tobacco: A Systematic Review and Interpretive Synthesis of Quantitative and Qualitative Research

“…Cessation medicines may be viewed as addressing only one aspect of addiction (nicotine dependence), which smokers may not consider to be the most important factor driving their addiction. Furthermore, many have written of the increasing stigmatisation of smokers that has occurred as tobacco use has become denormalised 11,[86][87][88][89] . The extent to which medicinal cessation aids are associated with notions of substance (nicotine) addiction and the identity of a nicotine addict may make them unattractive to smokers given the techniques used by smokers to distance themselves from 'addiction' 90 .…”

Is it the nicotine? Australian smokers’ accounts of nicotine addiction

“…Despite moves towards medicalizing tobacco use through diagnostic labels and the prescription of cessation medications, such as nicotine-replacement therapy (NRT), smoking still remains largely incongruent with dominant notions of addiction (Morphett et al Forthcoming;Bell and Keane (2012) suggest this is because while smokers are dependent on regular nicotine administration to avoid withdrawal symptoms, they live normal and productive lives and only face (short-term) physical and psychological effects in the process of stopping smoking. The legal status of tobacco as a consumer good that can be purchased at any general retailer with minimal restrictions also sets it apart from most other addictive substances which are generally prohibited (e.g.…”