People often stigmatize smokers and many public health messages are stigmatizing. Stigmatization has also been proposed as a public health strategy to decrease smoking prevalence. But does stigmatization actually motivate quitting, or does it have the opposite effect? The answer to this question has important implications for health education programs, smoking cessation programs, and public health policy. We know little about how smokers react to stigmatization and the causal consequences. Particularly understudied are reactions to stigma within social contexts, such as culture and social status. In the proposed research, guided by the Model of Stigma Induced Identity Threat, two experimental studies in the US and Denmark will examine the effects of stigmatizing smokers among people of various levels of social status. Identity threat (stigmatization) will be induced i smokers by activating concerns about smoking stigma; in Study 1 by making the stigma visible in a hiring situation and in Study 2 by reminding smokers that people find cigarette smoke and smokers disgusting. The effects of stigmatization are expected to cause smokers to experience emotional, behavioral, cognitive, and attitudinal effects that reduce the likelihood that they will quit smoking (Specific Aim 1). Specifically, stigmatization is expected to result in smokers experiencing greater physiological stress (Study 1), smoke with greater intensity (Study 2), experience greater cognitive depletion, have more favorable smoking attitudes, and minimize their personal health risk from smoking (Studies 1 and 2). Culture and social class are expected to attenuate these effects (Specific Aim 2). Specifically, Danish smokers will react more strongly to stigmatization compared to US smokers (because smoking is less moralized in Denmark and Danish smokers reject stigmatization more strongly) and smokers of higher social status will react more strongly compared to smokers of lower social status (because smoking is less common among members of higher social status groups and higher status smokers reject the implied demotion to a lower social status). This research will provide valuable insights into the consequences of stigmatization and thus lay the groundwork for more effective educational interventions and smoking cessation programs. Understanding cultural and class-based reactions to stigmatization is particularly important in the US with its large and diverse immigran and refugee populations as well as persistent high rates of smoking among people with less education. Thus, this research will contribute to reaching the Healthy People 2020 objective of reducing adult cigarette smoking in the US to 12% from the 2012 rate of 18%.
Smoking continues to be the single most important risk factor for cancer, heart disease, stroke, pulmonary disorders, and many other illnesses. This research will provide valuable insights into the role of culture and social class in smokers' reactions to stigmatization and thus lay the groundwork for more effective educational interventions and smoking cessation programs. Understanding cultural and class-based reactions to stigma is particularly important in the US with its large and diverse immigrant and refugee populations as well as continued high rates of smoking among those with the least education. This research will contribute to reaching the Healthy People 2020 objective of reducing adult cigarette smoking in the US to 12% from the 2012 rate of 18%.
