Public health policies which stigmatise smoking can actually make it harder for people to quit because they become angry and defensive and the negative messages lead to a drop in self-esteem, a new study has found. The findings highlight the potential for negative stereotypes to backfire, especially when it comes to public health campaigns.
“Consequences of stigmatising stereotypes ranged from increased intentions to quit smoking to increased stress to greater resistance to quitting smoking,” said Rebecca Evans-Polce, postdoctoral fellow, The Methodology Center and the Bennett Pierce Prevention Research Center, Pennsylvania State University.
Evans-Polce and colleagues from the UK, 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 researchers found 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,” said Sara Evans-Lacko, research fellow, London School of Economics and Political Science.
One study found that 30 to 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. 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, showing 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.
Evans-Lacko said the evidence shows that vulnerable groups with few coping resources would benefit from anti-smoking programmes that do not stigmatise smoking but focus instead on the benefits of giving up.

The findings are published in the journal Social Science & Medicine.

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