Stigma and Smoking: The Consequences of our Good Intentions Jennifer Stuber PhD Assistant Professor

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Stigma and Smoking The Consequences of our
Good IntentionsJennifer Stuber PhDAssistant
ProfessorUniversity of Washington
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Allan Brandt, medical historian, on stigma and
smoking (1998)

• In the last half century the cigarette has been
  transformed. The fragrant has become foul An
  emblem of attraction has become repulsive. A
  mark of sociability has become deviant. A
  public behavior is now virtually private. Not
  only has the meaning of the cigarette been
  transformed, even more the meaning of the smoker
  who has become a pariah the object of scorn
  and hostility.

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Consequences of smoker-related stigma
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Predictors of smoker-related stigma

• Individual attributions for smoking
• Blaming smokers for the poor health of children
• Experiences of differential treatment
• Explicitly negative normative evaluations of
  family and friends
• Self-identifying as White
• Having more education

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Disparities in media campaign effectiveness

• Some media campaign messages appear less
  effective in promoting quit attempts among
  less-educated populations compared with those who
  have more education. There is a need to develop
  media campaigns that are more effective with less
  educated smokers.
• Niederdeppe et al. 2008

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Disparities occur at different stages

• Differences in meaningful exposure Does your
  target population understand and remember the
  message and does it produce the desired outcome?
  Also, low SES smokers differ from high SES
  smokers in access to particular media and
  patterns of media use.
• Motivational responses may vary even if theres a
  resonating message
• Responses to media campaigns may not translate
  into sustained abstinence from cigarettes.

Niederdeppe et al.(2008)
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Best practices

• Media campaigns should conduct formative research
  to understand the media use preferences and
  drivers of tobacco cessation among low SES
  smokers
• Media campaigns should consider the literacy
  needs, language preferences, and cultural values
  of low-SES smokers, including when applicable
  persons of color when designing messages
• Media campaigns should strive for as much
  exposure as possible, including paid media
  campaigns, donated media time and direct
  marketing

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Best practices (contd)

• Media campaigns should deliver a consistent
  messages from a variety of trusted sources over a
  long period of time
• Media campaigns should place information in
  medium that will reach intended target audiences
• Media campaigns should be combined with other
  tobacco control program components such as
  community mobilization that have been shown to
  work for low SES populations.

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Stay away from media campaigns that belittle or
blame

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Food for thought Burris (2008)

• A stigma of smoking might contribute to fewer
  people smoking, but so would other methods less
  harmful to those who do not quit. Has the stigma
  attached to injection drug use been a net plus
  for public health? It is stigma or simply more
  systematic law enforcement that has reduced drunk
  driving? The key is to disapproval without
  eliciting a rejection of the disapprover Where
  is the evidence that inculcating a sense of
  spoiled identity is a good way to get people to
  adopt healthier behaviors?

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