Smoking to fit a stigmatised identity? A qualitative study of marginalised young people in Australia

Abstract

In countries with comprehensive tobacco control, smoking is increasingly denormalised, with smokers subject to social stigmatisation. Qualitative research and commentary about denormalisation and stigma has largely focused on the impact on current or former smokers. Little attention has been given to the interaction between existing stigma among socially marginalised and disadvantaged young people and its role in smoking uptake, maintenance and resistance to quitting, or remaining a non-smoker. This article draws on a qualitative (grounded theory) study of young people aged 16-25 years who attended social services for at-risk youth in an inner city area in Australia, to explore the intersection between stigmatised identity and smoking in a context of increasing smoking denormalisation. Drawing on theoretical conceptualisations of stigma, we outline processes by which participants accept and apply social labels, internalise or distance themselves from stigmatised identities, and the influence of labelling on smoking trajectories, to demonstrate how the persistent dilemma of stigma shapes and reinforces smoking behaviour. The study highlights the need for tobacco control initiatives to align and integrate with broader initiatives to address structural inequality and social disadvantage.

Places to Smoke: Exploring Smoking-Related Practices among Danish Adolescents

“…Thus, when smokers practice smoking at distinct places, it indicates that smoking has a negative connotation. Moreover, many smokers experienc stigmatization [ 44 , 45 ], among others, due to perceptions that smokers have a ”devalued identity” [ 7 ] (p. 313). Research has found that adolescents may feel pressured to find alternative places to smoke to demonstrate agency relative to discourses about smoking as an unhealthy behavior [ 46 ].…”

“…This is in line with results from Moore, who found that the negative perception of smokers was ascribed to the entire identity of the person who smokes [ 47 ]. Being a smoker can result in loss of status as a consequence of smoking stigmatization [ 7 , 39 , 48 ]. The adolescents’ smoking practice and the practice of smoking at distinct places might, therefore, be a way to avoid stigmatization.…”

“…Thus, smokers can have other social identities with which they experience or have been experiencing disadvantages; smoking can become a behavior to oppress or reform current or former status. Hefler and Carter, for instance, found that for adolescents who had poor academic achievement, smoking had a social aim and was a way to take on another identity, and hence smoking could act as an escape from an already stigmatized identity [ 7 ]. In this sense, smoking-specific places, and thus smokers’ limited access to the school ground, as well as smokers’ experience of stigmatization, become an experience that intersects with other circumstances or identities.…”

“…Smoking, as well as refraining from smoking, are both considered to be important identity statements [ 6 ]. Furthermore, research has found that smoking interferes with other life circumstances, and engaging in, as well as refraining from smoking, can be a way to internalize or resist a stigmatized identity [ 7 ]. Smoking identity can be deployed as social power, as smoking is found to help individuals feel included, express membership in their social groups, and maintain an identity that is valued within these groups [ 8 ].…”

Stigma and Smoking in the Home: Parents’ Accounts of Using Nicotine Replacement Therapy to Protect Their Children from Second-Hand Smoke

“…A grounded theory study of 18 young (16-25 years), disadvantaged Australians described stigma internalisation, self-labelling, and experience of stereotyping. Smoking was identified as a cause and consequence of stigma and non-smoking was linked to stigma resistance [68]. Stigma resistance against being viewed as an "irresponsible smoking mother" has been reported in Scottish disadvantaged mothers [36], (p.499).…”