Smoking and the emergence of a stigmatized social status

Abstract

An increase in the social unacceptability of smoking has dramatically decreased tobacco use in the USA. However, how policies (e.g., smoke free air laws) and social factors (e.g., social norms) drive the social unacceptability of tobacco use are not well understood. New research suggests that the stigmatization of smokers is an unrecognized force in the tobacco epidemic and could be one such mechanism. Thus, it is important to investigate the sources of smoker-related stigmatization as perceived by current and former smokers. In this study we draw on the broader literature about stigma formation in the context of the tobacco epidemic and examine the role of attribution, fear, tobacco control policies, power and social norms in the formation of smoker-related stigma. We test hypotheses about the determinants of stigma using a population-based sample of 816 current and former smokers in New York City. The results show that perceptions of individual attributions for smoking behavior and fear about the health consequences of second hand smoke are important influences on smoker-related stigmatization. Structural forms of discrimination perpetrated against smokers and former smokers (e.g., company policies against hiring smokers) are also related to smoker-related stigma. Respondents with more education perceive more smoker-related stigma than respondents with less education and, Black and Latino respondents perceive less smokerrelated stigma than White respondents. Social norms, specifically family and friends' expressed disapproval of smoking, contribute to the formation of smoker-related stigma. These findings suggest important points of leverage to harness the powerful role of stigma in the smoking epidemic and raise concerns about the possible role of stigma in the production of smoking disparities.

Contrasting Smokers' and Snus Users' Perceptions of Personal Tobacco Behavior in Norway

“…It is possible that the smoking ban introduced in Norway in 2004 decreased the social status of smoking and increased the attractiveness of snus as a substitute for nicotine delivery in places where smoking is forbidden (K. E. Lund, 2006). Smoking has now become a deviant behaviour, and the perceived stigma experienced by smokers has been highlighted in several studies (Graham, 2012;Ritchie et al, 2010;Stuber et al, 2008). Our study shows that smokers perceive negative social disapproval and moral judgement about their smoking.…”

“…Perceived social norms towards smoking were measured by questions referring to devaluation of smoking behaviour (Stuber et al, 2008).…”

“…Cigarette packs carry graphic health warnings about cancer, stroke, emphysema and heart failure, but snus boxes have warnings only in a text format and these focuses exclusively on the potential addictiveness. Fuelled by governmental actions, such as smoke-free policies and media campaigns stressing the danger of second-hand smoke, smoking has become increasingly deviant (Graham, 2012;Peretti-Watel, Beck, Legleye, & Moatti, 2007;Ritchie, Amos, & Martin, 2010;Stuber, Galea, & Link, 2008).…”

“…Differences in trend directions, user profiles and social status between smoking and snus use are observable at a macro level, but how does the users themselves evaluate their own smoking and/or snus use behaviour? One way of investigating whether the users of cigarettes and/or snus experience acceptance or deviance regarding their own behavior is to analyze smokers and snus users' experience of negative self-evaluative emotions (Dijkstra & Buunk, 2008) and aspects of perceived smokers stigma (Stuber et al, 2008).…”

The Relationship between Drug User Stigma and Depression among Inner-City Drug Users in Baltimore, MD

“…Yet, several studies suggest that the stigma of tobacco smoking may have unintended negative consequences, including discrimination, negative mental health, and delay in seeking medical care. 42 Increasing the stigma of using illicit drugs may increase drug users' self stigma and the stigmatizing behaviors of others. This in turn may result in impaired access to treatment of drug use, depression and subsequent relapse, and greater affiliation with active drug users, which is associated with continued drug use.…”