New evidence released today shows that public health policies targeted at smokers may actually have the opposite effect for some people trying to quit.
A review led by LSE Research Fellow Dr Sara Evans-Lacko indicates that stigmatising smoking can, in some cases, make it harder for people to quit because they become angry, defensive and the negative messages lead to a drop in self-esteem.
The findings, published in Social Science & Medicine, highlight the potential for negative stereotypes to backfire, especially when it comes to public health campaigns.
Dr Evans-Lacko and academic colleagues from the US, Brazil and Germany conducted a review of almost 600 articles relating to smoking self-stigma.
While the evidence shows that stigmatising smoking may prompt some individuals to quit, the authors say that health policies could instead focus on more positive strategies, reinforcing the benefits of giving up smoking rather than reiterating negative stereotypes.
“The stereotypes that smokers deal with are almost universally negative,” Dr Evans-Lacko says.
“One study found that 30-40 per cent of smokers felt high levels of family disapproval and social unacceptability and 27 per cent felt they were treated differently due to their smoking status. Another study found that 39 per cent of smokers believed that people thought less of them.
“The stigma for parents who smoke is particularly strong,” Dr Evans-Lacko added.
In multiple studies, smokers used words such as “leper,” “outcast,” “bad person,” “low-life,” and “pathetic” to describe their own behaviour.
The stigma surrounding smokers leads to a number of different outcomes, including relapses, increased resistance to quitting, self-induced social isolation and higher stress levels.
Other studies examined gender biases in relation to smokers, revealing that Pakistani and Bangladeshi women who smoked were seen as “shameful” and “tainted” whereas male smokers from the same culture were viewed as “macho”. Another study showed that women in general regret taking up smoking more than men do.
Dr Evans-Lacko says the evidence shows that vulnerable groups with few coping resources would benefit from anti-smoking programmes which do not stigmatise smoking but focus instead on the benefits of giving up.
“The Downside of Tobacco Control? Smoking and Self-Stigma: A systematic review” is published in Social Science & Medicine. For further information please contact Dr Sara Evans-Lacko at S.Evans-Lacko@lse.ac.uk or +44 20 7955 6028.
Notes for editors
The authors who contributed to the paper included: Dr Sara Evans-Lacko (LSE), Dr Georg Schomerus (University of Greifswald), Dr Rebecca Evans-Polce (Pennsylvania State University), and Dr Joao Castaldelli-Maia (University of Sao Paulo).
2 November 2015