Nicotine - Stigma

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Stigma and stigmatizing language lead to viewing people as less worthy and can lead to bias, racism, and discrimination. Stigma can affect the mental health of the stigmatized, may inhibit their ability to achieve wanted changes in their lives, and may cause them to avoid medical care or helpful services.

Smoking (Nicotine) Stigma and the use of "Smoker"

Publication Policies - Smoker

2023: New policy of people-first language to replace ‘smoker’, ‘vaper’ ‘tobacco user’ and other behaviour-based labels

  • ..."Tobacco Control is instituting a new policy of people-first language when referring to people who use tobacco and related products. Terms such as ‘smoker’, ‘vaper’ and ‘tobacco user’ (and their various iterations) should no longer be used as general descriptors."
  • "However, people-first language does not invalidate how people may choose to self-identify. It provides a broader conceptualisation which reduces the potential for stigma, resists tobacco industry narratives and promotes greater precision and accuracy, as well as creating space which recognises these self-claimed identities can change."


2021: E-Cigarette Summit: Stigma and tobacco harm reduction: what we can learn from other health behaviors

  • Prof Scott Leischow
  • Stigmatizing smoking has been at the heart of tobacco control efforts for decades, which may drive more people to quit but at the same time potentially create new difficulties for smokers, including self-isolation, creation of social groups that might become ‘hardened’ to changing smoking behaviors, and perceptions by the user and society that complete abstinence is the only option. The stigma associated with a wide variety of behaviors has impeded progress toward improving population health in some cases, such as the reticence in making products and services available that could reduce the risk of communicable disease (eg needle exchanges), as well as harm reduction products that could benefit users and society when an individual addicted to a substance is not able to or chooses not to become completely abstinent (eg NRT, ENDS, smokeless tobacco). This presentation will explore some of the conflicting aspects of stigma in tobacco control, explore similarities and differences regarding the stigma of using of different addicting substances, and consider some research, practice and policy directions.

Studies, Papers, Reports - Smoker

2022: Reducing stigma triggered by assessing smoking status among patients diagnosed with lung cancer: De-stigmatizing do and don't lessons learned from qualitative interviews

  • Patients expressed clear preferences for CCPS to refrain from using judgmental labels when assessing smoking history, including a preference for questions such as “have you smoked cigarettes in the past 30 days” rather than “are you a smoker?” . This perspective is consistent with the broader clinical efforts and dissemination of resources to reduce illness-related stigma through the increased use of person-first language and other bias-free language in clinical care and research. [emphasis added]

2022: A Person-Centered Approach to Moralization—The Case of Vaping

  • The public should be educated about the difficulties in exercising self-control in addictions, such as nicotine addiction, and other lifestyle-related afflictions, such as obesity, so that moralization and its social consequences are less likely to occur. Such cognitively-oriented initiatives should be accompanied by emotionally oriented ones, aiming to sensitize the public to the moralized groups’ suffering.

2021: Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress

  • To balance these factors, complementary campaigns can address the role of media and the tobacco industry in promoting smoking, making it clear that smoking is not solely driven by personal decision making, emphasize that smoking is a physical and behavioral addiction and not a personal moral failing, use person-first language (people who smoke vs. smokers), emphasize the positive benefits of quitting, and acknowledge that quitting is difficult and may take multiple tries but there are treatment strategies that can help. [emphasis added]

2020: Changing the Language of How We Measure and Report Smoking Status: Implications for Reducing Stigma, Restoring Dignity, and Improving the Precision of Scientific Communication

  • However, the descriptors we commonly use to classify people who smoke may inadvertently perpetuate harmful, stigmatizing beliefs and negative stereotypes. In recognizing the power of words to either perpetuate or reduce stigma, Dr. Nora Volkow—Director of the National Institute on Drug Abuse—recently highlighted the role of stigma in addiction, and the movement encouraging the use of person-first language and eliminating the use of slang and idioms when describing addiction and the people whom it affects.
  • In this commentary, we make an appeal for researchers and clinicians to use person-first language (eg, “people who smoke”) rather than commonly used labels (eg, “smokers”) in written (eg, in scholarly reports) and verbal communication (eg, clinical case presentations) to promote greater respect and convey dignity for people who smoke. We assert that the use of precise and bias-free language to describe people who smoke has the potential to reduce smoking-related stigma and may enhance the precision of scientific communication. [emphasis added]

2020: Stigma, Opioids, and Public Health Messaging: The Need to Disentangle Behavior From Identity

  • "Indeed, an oft-spoken proverb among those who work in tobacco control is “There is no such thing as a‘smoker,’ there are only people who smoke." This framing intentionally creates space to decouple behavior from identity, so that unhealthy behavior (i.e., smoking) can be actively denormalized without perpetuating stigma against those who engage in it. It underscores that individuals who smoke maintain their core humanity and value as human beings, despite engaging in a socially unacceptable behavior. Once they change this target behavior, they are no longer targeted for disapproval." [emphasis added]

2019: The ironic effects of stigmatizing smoking: combining stereotype threat theory with behavioral pharmacology

2016: Exploring Issues of Comorbid Conditions in People Who Smoke

  • For the purposes of this manuscript, we have attempted to reduce the stigma associated with smoking and support a more holistic approach by referring to “individuals who smoke” or “patients who smoke” rather than referring to people as “smokers.” In other words, tobacco dependence is just one component of an individual’s health behaviors and diagnoses. [emphasis added]

2015: NICE style guide

  • Smoker: Do not use. In line with our house style, we do not label people. Use 'people who smoke'. [emphasis added]
  • Don't label people with their condition: we would never say 'epileptics', 'schizophrenics', 'smokers', 'drug-takers'. Use the following as a guide: 'people with epilepsy', 'people with schizophrenia', 'people who smoke', 'people who take drugs'.

2013: Partners in Change Report on participation in a health behaviour change course to address smoking in pregnancy in support of a fair and equal Tasmania

  • Appendix C. Comments on antcipated changes to practce: 'people who smoke' not 'smoker' [emphasis added]

2013: After the Smoke Has Cleared: Reflections from a Former Smoker and Tobacco Researcher

  • Sci-Hub (full paper)
  • I use the terms “tobacco user” and “people who smoke” to counter the pejorative implications of the term “smoker(s)”
  • I found that most of the tobacco and health advocates I encountered held dismissive and demeaning views about people who smoke...

2012: Crossing the Smoking Divide for Young Adults: Expressions of Stigma and Identity Among Smokers and Nonsmokers

  • The themes identified illustrated how nonsmokers’ perception of smoking as illogical and self-destructive supported harsh reactions, including stigmatizing behaviors that antagonized smokers.
  • A supportive/empathic tobacco-control denormalization approach could enhance young adult smokers’ willingness to make the transition from smoker to smoke free and elicit stronger support for their efforts from nonsmokers.

Articles, Websites, Blogs - Smoker

2022: Time to Stop Using the Word “Smoker”: Reflecting on the Role of Language in Advancing the Field of Nicotine and Tobacco Research

  • From legislatures to schools to workplaces, as well as in scientific discourse and clinical practice, the past few decades have seen a move away from labels such as “user,” “addict,” or “alcoholic,” for their lack of precision, negative connotation, and the way they equate the person with behavior or condition. Despite this, “smoker” remains in use in tobacco research, as well as in clinical settings and public health policy.

2022: PWS – People Who Smoke

  • The word “smoker” is a disparaging term, like “addict” or “alcoholic”
  • The use of a label such as “smoker”, “addict” or “illegal” divides people up into “us” and “them”. It is a slippery slope toward calling certain groups or tribes “vermin” or “cockroaches”

2022: How to Reduce Mental Health Stigma, Smoking Stigma in the Workplace

  • It can be tempting to dismiss these kinds of negative labels as simply semantics, but research has shown that language matters. Using person-first language like “people who smoke” instead of “smokers” acknowledges the tenacity of this disease, conveys dignity and greater respect, and can reduce smoking-related stigma.
  • People who smoke are often perceived as having negative personality and social traits.
  • These aren’t silent biases either: these negative perceptions influence attitudes about people who smoke, which in turn influence non-smokers’ willingness to interact with people who smoke.
  • ...there are 21 states that do not offer employment protection to tobacco users, allowing employers to refuse to hire people who smoke. Unsurprisingly, people who smoke have a harder time getting hired. For example, the chances of getting a job within a year is reduced by 24% for unemployed job seekers who smoke compared to non-smokers, even when other factors like criminal history are considered.
  • And even with a job, the stigma still carries through, as people who smoke earn 20% less compared to non-smokers.
  • Stigma associated with many mental health conditions like depression is now a well-recognized issue. By acknowledging this stigma, it has allowed considerable progress to be made. Unfortunately, the same progress has not been made in reducing the stigma of substance use disorders like nicotine addiction.

2021: A New Guide Encourages the Use of Language that is Respectful of Patients, Free of Stigma, Inclusive, and Equitable

  • End stigma: Promote judgment-free, bias-free language. Try 'person who smokes' rather than 'smoker.' [emphasis added]
  • 'A person with nicotine dependence' instead of 'a nicotine addict.'

2021: Statements about people who smoke found on the internet

Tweets about discontinuing the use of "Smoker"

Skip Murray

  • What would it take for me to convince the scientific and public health communities to switch from the stigmatizing word "smokers" and switch to something else? Perhaps "people who smoke (PWS)."

Cristine Delnevo, PhD, MPH, FAAHB

  • You're 100% correct - admittedly, when on autopilot, I've written "smokers" and revised when editing. I'm a fallible human, a work in progress, and trying to do better. What would it take? keep calling us out on it! we need to retrain our brains.

Ruth Malone PhD

  • This is right & we’ve had a lot of conversations about this at TC_BMJ but I know some still slip through. Anyway, the point is our concern ought to focus on these horrible products, not on individual behaviors. Thank you for this reminder.

Amanda Palmer, PhD

  • When reviewing articles that use the word "smoker" or something similar, I suggest to the authors to use person-centered language and then write a nice note to the editor encouraging wiggle room with the word limit

Dana Elizabeth Bourne, MPH

  • Hearing "smoker" a @healthvermont we prefer "person who uses tobacco" or "tobacco user" to remove the stigma, and use people-first language.

Examples of an alternative to "smoker" - PWS (People Who Smoke)

CDC - Centers for Disease Control and Prevention: Preferred Terms for Select Population Groups & Communities

  • Instead of this… "Smokers," Try this... "People who smoke"

2022: Smoking and social housing from LIN and ASH

  • "People who smoke" are mentioned 16 times in this report. One example: "These particular examples also shine a light on the potential of e-cigarettes for people who smoke and live in social housing. Reviews of the evidence by the National Academies of Sciences, Engineering and Medicines in the US and the UK Committee on Toxicity have concluded that the relative risk of adverse health effects from e-cigarettes are likely to be substantially lower than from smoking. E-cigarettes have also been shown to be an effective aid for quitting, in clinical trials and at population level, with some evidence suggesting they are even more effective than traditional forms of nicotine replacement therapy, like patches and gum. They also appear to have been particularly valuable among groups who face higher levels of addiction and more barriers to quitting, for example among people experiencing homelessness and people with mental health conditions. Considered alongside the evidence from the ‘Swap to-Stop scheme, e-cigarettes therefore present a real opportunity to substantially benefit people who smoke and live in social housing."

Health Canada

  • "Today, to mark World No Tobacco Day, the Honourable Patty Hajdu, Minister of Health, announced $3 million in funding for a national social marketing campaign to encourage people who smoke to quit."

American Cancer Society

  • "Some people who smoke choose to try e-cigarettes to help them stop smoking. Stopping smoking clearly has well-documented health benefits...People who have already switched completely from smoking to e-cigarettes should not switch back to smoking (either solely or along with e-cigarettes), which could expose them to potentially devastating health effects."

Studies, Papers, Reports - Smoking

2022: What low-income smokers have learned from public health pedagogy: A narrative inquiry

  • Frohlich et al and others have suggested that public health educational messages may have the unintended consequence of marginalizing low-income smokers and unintentionally contributing to health disparities. Our study participants also point to healthcare professionals as an important group who may be contributing to these feelings. With this in mind, efforts to educate healthcare providers on how their actions may be perceived as judgmental or lacking in compassion about the effects of nicotine withdrawal are warranted.

2020: Stigma and Smoking in the Home: Parents’ Accounts of Using Nicotine Replacement Therapy to Protect Their Children from Second-Hand Smoke

  • However, smoking prevalence remains disproportionally high in socioeconomically disadvantaged groups.
  • Smoking stigma, particularly self-stigma, underpinned accounts, with two overarching themes: interplaying barriers and enablers for creation of a smoke-free home...
  • Personal motivation to abstain or stop smoking empowered participants to reduce or quit smoking to resist stigma. For those struggling to believe in their ability to stop smoking, stigma led to negative self-labelling.
  • Whilst denormalisation of smoking has been a useful public health tool for reducing smoking rates in the UK, it is arguable that this can lead to unhelpful stigmatisation of already vulnerable disadvantaged groups.

2019: ES13.05 Stigma and Impact of Tobacco Control Policy

  • The stigma reduces the funding available for lung cancer research. In the US, federal funding for lung cancer research per lung cancer death is only 15% of the funding amount for breast cancer per breast cancer death.
  • In a Global Lung Cancer Coalition survey, one in five people (21%) agreed with the statement that they have less sympathy for people with lung cancer than for people with other types of cancer.
  • Stigmatization of smokers has the greatest impact on the socioeconomically deprived, the disadvantaged populations. These populations have the highest prevalence of smokers and encounter the stigma of their race or disadvantage (poverty, disability, sexual preference, behavioral health etc.) in addition to the stigma associated with smoking.
  • This stigmatization leads people who smoke to be less likely to seek medical care when they have symptoms, more likely to lie about their smoking, more likely to be refused access to care including curative surgery for early stage lung cancer unless they quit smoking, less likely to be offered smoking cessation help if they are uncomfortable disclosing their smoking status due to stigma and bias from their healthcare professional.


  • Thus, stigmatization led smokers toward emotional, cognitive, and attitudinal reactions that might make them less likely to quit.

2018: Smoking-Related Stigma: A Public Health Tool or a Damaging Force?

  • This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force.

2017: Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use

  • Consistent with previous research we have found that smokers’ who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts and report a stronger intention quit smoking in the future.
  • It is also important to recognize the potential negative consequences associated with stigmatizing smokers, who may seek ways to evade stigma by segregating themselves into groups accepting of smoking and perhaps fostering the development of fatalistic attitudes about their ability to change their smoking behavior, which make quitting smoking harder to accomplish. Thus, behavioral interventions for smoking cessation might include addressing stigma-related issues as part of the quitting process.

2015: Validity and Reliability of the Internalized Stigma of Smoking Inventory: An Exploration of Shame, Isolation, and Discrimination in Smokers with Mental Health Diagnoses

  • In addition to the health disparities experienced by smokers, psychosocial factors such as smoking stigma can cause additional strain on health, and may thwart positive behavior change. Smoking stigma can be defined as a social process by which exclusion, rejection, blame or devaluation occurs,7 in this case related to smoking or being identified as a smoker. Stigma can be categorized as: 1) internally-focused self-stigma resulting from the internalization of public stigma and characterized by statements about the individual's worth, e.g., “I am worth less because I smoke”; 2) perceived or felt stigma, which is an awareness of devaluation or stereotype in work, social, and everyday situations, and includes fear of being stigmatized, experiencing external blame, and social isolation; or 3) enacted stigma, which refers to acts of discrimination perpetrated on stigmatized individuals.
  • We would consider, however, efforts to induce stigma as abjectly wrong and avoidable. Instead, treatment engagement strategies could emphasize stigma-reduction as an ancillary benefit – i.e., messaging that quitting smoking can reduce stigma, rather than messaging aimed at increasing stigma to induce quitting.

2012 Self-stigma, Stress, and Smoking among African American and American Indian Female Smokers: An Exploratory Qualitative Study

  • However, continued smoking was also a source of negative emotion, as women felt shame, guilt and low self-esteem over their inability to quit, which was perceived by some as indicative of weakness. These negative self-perceptions are consistent with stigmatized views of smokers held by the public. Women also expressed feelings of defiance about their smoking despite pressure to quit and identified external factors which contributed to their inability to quit. The negative emotions, self-stigma and shame experienced by low income American Indian and African American women smokers may contribute to continued smoking and disrupt quit attempts. Additional research is needed in order to develop effective tobacco cessation interventions for this group.

2009: The Psychological Effects of Social Stigma: Applications to People with an Acquired Hearing Loss

  • To various extents, people who smoke are devalued as individuals and discredited as a member of society; they are stigmatized.

2008: Tobacco control and the inequitable socio-economic distribution of smoking: smokers’ discourses and implications for tobacco control

  • Full Study on Sci-Hub
  • Few low SES smokers questioned their smoking status, instead framing smoking as a ‘fact of life’. However, there was also a clear sense that tobacco control, and its adherents, are contributing to a sense of stigmatised identity for these smokers.

2006: Pollution, peril and poverty: a British study of the stigmatization of smokers

  • Stigma is a mark of social disgrace that arises within social interaction (Goffman, 1963). It disqualifies bearers of the mark from full social acceptance.
  • The results suggest that British smokers are identified via a negative aesthetic marker, consisting of smell and appearance. Like all stigmatized marking, they are not assessed merely at a cognitive level, but emotionally too (Jones et al., 1984). Non-smokers report repulsion, dislike, irritation, sickness and, most often, disgust in the face of them.

Full Study on Sci-Hub

Articles, Websites, Blogs - Smoking

2015: Smoking stigma can hurt efforts to quit

  • Public health campaigns that stigmatize smoking can backfire, according to a study published Monday, leading some people to become so angry and defensive that they refuse to quit and others feeling so bad about themselves that they give up trying.
  • Smokers reported feeling shame, guilt and embarrassment for their smoking behavior and used words such as “leper,” “outcast,” “bad person,” “low-life” and “pathetic” to describe themselves, the study found. These feelings increased after failed attempts to quit smoking.

Studies, Papers, Reports - Employment and/or Insurance

2023: Youngkin says he will sign legislation ending higher insurance premiums for tobacco users

  • “Tobacco users tend to have lower incomes, which is often a barrier to coverage,” Barber said. “Charging them more to access the care they need … is harmful and inequitable. The VPHA is cautiously optimistic that this barrier will go away, and people will be able to afford quality coverage and get the care they need for their tobacco use and beyond.”

2018: A qualitative review of tobacco research related to public and structural stigma.

  • Our review found that some smokers experience self-stigma such as self-loathing and shame as a result of public stigma. The few studies on structural interventions suggest that they affect some smokers in counterproductive ways, such as eliciting defiance and/or prompting public and self-stigma.
  • Importantly, no studies examine stigma-related impact of newer structural interventions, such as higher insurance premiums or worksite policies to employ only nonsmokers.
  • To advance the field, it will be critical to pinpoint whether, when, and how denormalization becomes stigmatization. [emphasis added]
  • Removing the stigmatizing aspects of existing approaches, and creating new interventions that avoid stigmatizing smokers, may help further enhance the reach and effectiveness of tobacco control.

2017: Stigmatizing the Unhealthy

  • Sci-Hub (full paper)
  • The very fact that the Affordable Care Act moved away from health status-based rating in the individual market, with conspicious exceptions for tobacco use and wellness program participation, is telling. The ACA then suffers from an internal tension. On one hand, its supporters framed it as “a civil rights bill for the sick.” On the other, despite eliminating health insurance practices that explicitly disadvantage people based on health, the ACA permits — even encourages — health insurers to charge more to people who use tobacco. Pursuant to the tobacco surcharge, an insurer can opt to charge a tobacco user up to fifty percent more for the same health plan. While many health insurance companies may not opt to charge the full penalty, the ones that do could price out smokers and other tobacco users.
  • It then comes as no real surprise that the Affordable Care Act’s tobacco surcharge may actually backfire, leading people to drop health insurance rather than to quit smoking. Given both the intervention’s ineffectiveness and its lack of a clear justification for regulating tobacco use and no other health status, we propose that singling out tobacco users may be the result of animus.
  • The tobacco surcharge singles out smokers and other tobacco users, thus communicating
    • (1) that tobacco use has social meaning as a category,
    • (2) that using tobacco is socially undesirable,
    • (3) that classifying people based on their tobacco use is acceptable, and
    • (4) that tobacco users should face disadvantage in the form of a heightened premiums.
  • In other words, the tobacco surcharge mirrors the process of stigmatization. Thus, even if the tobacco surcharge is not driven by animus against smokers, the ACA could lay the foundation for stigmatizing tobacco users.
  • Smokers face similar kinds of regulation outside health insurance. Some employers refuse to hire nicotine users of any kind. As one set of authors explain, workplace bans, “by sanctioning discrimination, abrogate smoker’s rights as ‘ordinary citizens’ by placing ‘them’ in a category that separates smokers from ‘us’(non-smokers).

2016: Smoking Cessation and the Role of Stigma: A Systematic Review

  • What emerged from this review is current anti-smoking campaigns are not effective for smokers who are living in poverty. These findings suggest that anti-smoking campaigns need to limit stigma and build programs that are effective for all socio-economic classes.
  • Anti-smoking campaigns have been used for the last three decades, and while there has been a decrease in smokers across the US, the number of smokers living in poverty has remained relatively unchanged. The research points to the use of stigma as a possible reason for smokers who are living in poverty to not stop smoking. The use of stigma to help a population, who may be stigmatized for multiple reasons, has shown through the research, to be a poor tool in moving them towards a smoke free life. The use of stigma in public health campaigns may lead to making things worse for smokers who live in poverty through discrimination in hiring policies and other unintended consequences.

2015: The Downside of Tobacco Control? Smoking and Self-Stigma: A systematic review

  • While there is evidence that internalizing smoking stigma may prompt some individuals to quit smoking, this review also suggests that smoking self-stigma can have profoundly negative consequences for some smokers and may make quitting more difficult.
  • Currently, there may be an overreliance on strategies which focus on negative reinforcement including both strategies to change smoking norms and increase smoke-free public spaces as well as more structurally stigmatizing policies such as basing hiring decisions and health insurance costs on smoking status.

2008: Smoking and the emergence of a stigmatized social status

  • Structural forms of discrimination perpetrated against smokers and former smokers (e.g., company policies against hiring smokers) are also related to smoker-related stigma.

Articles, Websites, Blogs - Employment and/or Insurance


  • Suggested words to use instead of relapse(d): recurrence (appears to be the most widely used), return, resume (resumption), slip, lapse, (use) episode, substance use (no strings attached to current, former, daily, random), revert, recent use... these and other suggestions can be found on this question posed on Twitter in the comments.

Articles, Websites, Blogs - Relapse

2019: It’s Time to Quit Using… Stigmatized Words Like Relapse

  • Much of society associates the term “relapse” with failure because of an antiquated and baseless condemnation of individuals with substance use disorder who do not become “cured” with their first treatment. Very often, there is immediate judgment.
  • I propose that if we want to help erase stigma, we choose to use the word recurrence rather than relapse. “Recurrence of substance use disorder” creates a more accurate connotation, one that is more consistent in the medical world.
  • Our language activates implicit cognitive scripts that give meaning to what we try to convey and communicate.

"Black Words - Example: Black Market"

Studies, Papers, Reports

2019: Communicating about Substance Use in Compassionate, Safe and Non-Stigmatizing Ways

  • Instead of "Black Market," use alternative terms such as "illegal supply," "unregulated market," "illegally obtained," "illegally produced," or "diverted."
  • “Black” is often used as an adjective to convey that something is illegal or otherwise “bad” (e.g., black market, blacklist, black sheep, blackmail, etc.), which has clear racist underpinnings.

2018: “Blacklists” and “whitelists”: a salutary warning concerning the prevalence of racist language in discussions of predatory publishing

  • This commentary addresses the widespread use of racist language in discussions concerning predatory publishing. Examples include terminology such as blacklists, whitelists, and black sheep. The use of such terms does not merely reflect a racist culture, but also serves to legitimize and perpetuate it.
  • The racism in such “black is bad, white is good” metaphors is inappropriate and needs to cease.
  • ...the word WHITENESS has 134 synonyms; 44 of which are favorable and pleasing to contemplate…Only ten synonyms for WHITENESS appear to me have negative implications—and these only in the mildest sense… The word BLACKNESS has 120 synonyms, 60 of which are distinctly unfavorable, and none of them even mildly positive…

Articles, Blogs, Websites

2021: Say This Instead: “Blacklist,” “Blackball,” “Blackmail,” “Black market,” etc.

  • "In a continuation of the “Say This Instead” series, let’s look at the pervasive symbolism of “white” as positive and “black” as negative in the English language. Words like “blackmail” (related to extortion), “blackball” (rejection), “blacklist” (banishment), and “black market” (illicitness) are so woven into the fabric of our language that we often don’t reflect on their racist overtones. The meaning of these phrases is always something undesirable. It perpetuates a systemic stigma caused by using the same terms that describe the color of our skin as a delineation between good and bad. Based on our use of these words, “black” is bad and “white” is good."

2020: Racist Language and Origins I Didn’t Always Know

  • The symbolism of white as positive and black as negative is pervasive in our culture. ...color is related to extortion (blackmail), disrepute (black mark), rejection (blackball), banishment (blacklist), and illicitness (black market).
  • "To be an antiracist means taking action to change inherit bias, implicit bias, systemic racism, covert bias, and micro-aggressions. While we may say things without malice or racist intent, we can do better by learning how to recognize and stop using language with racist origins, meanings, or connotations."


Articles, Websites, Blogs

2022: CTP Updates “Grandfathered Tobacco Product” Term to “Pre-Existing Tobacco Product”

  • On Aug. 19, FDA’s Center for Tobacco Products (CTP) updated the term “grandfathered tobacco product” to “pre-existing tobacco product” on all the Center’s systems.
  • Additionally, the term “grandfathered” – when used to describe someone or something exempt from a new law or regulation – has its roots in 19th century racist voting laws. Therefore, this terminology has been updated in accordance with CTP’s commitment to diversity, equity, inclusion, and accessibility.

2013: The Racial History Of The 'Grandfather Clause'

  • "Because of the 15th Amendment, you can't pass laws saying blacks can't vote, which is what they wanted to do," says Eric Foner, a Columbia University historian. "But the 15th Amendment allowed restrictions that were nonracial. This was pretty prima facie a way to allow whites to vote, and not blacks."

"Derogatory Terminology"

  • Comment from Skip, the creator of this wiki page:
    • Those of us who believe there is a place in the world for alternative nicotine products have witnessed years of stigmatization for people's nicotine use. I encourage all of us to think twice about our own use of stigmatizing words, especially when directed at those we don't agree with. We must remember that we sometimes seem like "zealots" to them, too. Name-calling, disrespectful attitudes, and hurtful words will never open the dialogue between opposing viewpoints. Don't be a PANTZ (pro-alternative nicotine and tobacco zealot).
    • Be kind - millions of people are dying from smoking. It is one thing to be enthusiastic, it is another thing to be a rude troll. Show your mission's credibility by treating others respectfully, even if they've come across as rude. We should teach by example.
    • Stick with issues, not personal attacks. Many of us did things when we were teens that our parents didn't know about. When it comes to the teen vaping issue, why are we attacking parents? How are they supposed to know what their kids are doing 24/7? With all the misinformation out there, why are we angry at their panic over their child's use of vapor products? Many falsely believe that vaping can kill their kids or turn them into "addicts" (with all the stigma attached to that word). We shouldn't stigmatize parents, call them names, crack jokes about them drinking wine, etc. We should show compassion for their fear and keep offering to have a conversation and work towards solutions.


  • Anti Nicotine and Tobacco Zealots
  • A derogatory label applied to individuals and groups focused on eliminating all nicotine and tobacco products without taking the continuum of risk into consideration. Some of those individuals believe that all forms of nicotine are harmful, and society would experience improved public health without the use of nicotine. Some of those individuals are hyper-focused on concerns about youth initiating nicotine use and struggle to include concerns for anyone who smokes. Much of this debate is focused on e-cigarettes. A good discussion on the lack of balance is in this paper: Balancing Consideration of the Risks and Benefits of E-Cigarettes


  • Term used when referencing Michael Bloomberg, his money, the organizations he financially supports, and his followers.


  • A pejorative term for a (most often white) woman (or rarely a man) perceived as entitled or demanding beyond the scope of what is reasonable.
  • Sometimes called "soccer moms."

Mass Murderers - Nazi - Homicide

  • Terms used by some pro-tobacco harm reduction advocates aimed towards those who they don't agree with. Claiming that people who don't support tobacco harm reduction are purposely causing the deaths of people who smoke.

Nanny State or Nanny Stater

  • Nanny State is sexist and pejorative--trying to say that the govt thinks we're all babies in need of a "nanny."
  • The term is attributed to British Conservative politician, Iain Macleod, who used it in a derogatory sense to criticize government intervention in people’s lives.
  • Example of better terminology: "supporter of state intervention to influence behavior"


  • A shill is someone who publicly helps or gives credibility to a person, company, industry, or organization without disclosing their close relationship or employment. In online discussion media, shills make posts expressing opinions that further interests of an organization in which they have a vested interest, such as a commercial vendor or special interest group, while posing as unrelated innocent parties.
  • Both sides of the debate tend to aim this slur (without proof) at people they disagree with. Often to accuse someone of working in the tobacco industry or accuse someone of having their pockets lined by a wealthy funder who pushes a specific agenda. It is an attempt to discredit another person.


  • The phrase is used in a derogatory way to deride those particularly on the left of the political spectrum, and those with progressive liberal views. The author Chuck Palahniuk used the term 'snowflake' as an insult in his 1996 novel Fight Club. But way back in early 1860s in Missouri, USA, a 'snowflake' was a person who was opposed to the abolition of slavery.

Tobacco Control =/= People Control



  • Califf (FDA)

Mom's Basement

Words Matter - Lessons Learned: Drugs, Alcohol, Race, Gender, Mental Health, Weight, etc.


Let's Break the Stigma

  • How are you doing? How are you really doing?

Studies, Papers, Reports

2023: The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

  • "The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed."

2022: Why language matters in alcohol research: Reducing stigma

  • The results of a separate manual search (n = 110) on the Wiley Online Database showed that approximately 30% of articles used the term "alcoholic" in a stigmatizing manner.
  • Stigmatizing language can perpetuate negative biases against people with alcohol use disorder. We encourage researchers to shift away from language that maintains discriminatory conceptions of alcohol use disorder. Reducing stigma has the potential to increase rates of treatment seeking and improve treatment outcomes for individuals with alcohol use disorder.

2021: Weight Bias and Stigma: Impact on Health

  • "Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider."

2021: Media framing of emergency departments: a call to action for nurses and other health care providers

  • "Two overarching themes were found. First, in ED-related media that portrays health care needs of people experiencing health and social inequities, messaging frequently perpetuates stigmatizing discourses..."

2020: A Primer to Reduce Substance Use Stigma in the Canadian Health System

  • Substance use stigma is prevalent throughout the health system and contributes to poorer quality of care and negative health outcomes.
  • Creating a stigma-free health system will require collaborative action and sustained commitment of key players across the health system.
  • Efforts to reduce substance use stigma within the health system must also acknowledge and address intersecting stigmas, including through initiatives not traditionally labelled as “anti-stigma interventions”.

2019: LANGUAGE MATTERS Using respectful language in relation to sexual health, substance use, STBBIs and intersecting sources of stigma

  • Words matter. Certain words can make people or groups feel excluded, and can also convey stereotypes, expectations or limitations based on a person’s identity...
  • Language changes. As societal values change over time, so does the language that is considered acceptable...
  • Mindset matters. Be open and empathetic, and encourage others to do the same...
  • Person first. Use ‘person first’ language: language that prioritizes someone’s identity and individuality above whatever other characteristic you might be describing...
  • Be inclusive. Try and use language that is as inclusive as possible to reflect the known or unknown diversity of your audience. For example, instead of using the terms husband or wife when unsure of the sexual orientation and/or marital status of who you are speaking with, use the term ‘partner.’ Similarly, when referring to a group of people, try ‘folks’ instead of ‘guys.’
  • Be specific. Use language that is consistent with how a person identifies and is comfortable for them...
  • Be critical. Before introducing or describing someone based on personal characteristics (such as race, gender identity, (dis)ability, use of substances, etc.), ask yourself whether it is relevant and necessary to do so...

2019: Biased labels: An experimental study of language and stigma among individuals in recovery and health professionals

  • Results provide further evidence that previously identified stigmatizing labels have the potential to influence medical care and medical practitioner perceptions of individuals with substance use disorders and should be avoided.

2018: Considerations for substance-use disorder language: cultivating a shift from 'addicts in recovery' to 'people who thrive'

  • "We consider the role language plays in the SUD treatment field and how the language and concepts the words convey keep individuals from growing through and past the SUD. We argue that a new understanding calls for a shift in language among providers of SUD care in which the culture of SUD treatment begins to emphasize 'thriving' rather than 'recovery' from SUDs."

2018: Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias

  • The general public, treatment professionals, and healthcare professionals have been found to exhibit an explicit negative bias towards substance use and individuals with a substance use disorder (SUD).
  • Results support calls to cease use of the terms "addict", "alcoholic", "opioid addict", and "substance abuser". Additionally, it is suggested that "recurrence of use" and "pharmacotherapy" be used for their overall positive benefits. Both "medication-assisted recovery" and "long-term recovery" are positive terms and can be used when applicable without promoting stigma.

2017: Stigma Experienced by Children and Adolescents With Obesity

  • Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth.

2013: Stigmatizing harm reduction through language: a case study into the use of "addict" and opposition to supervised injection sites in Canada

  • "The use of labels is one way stigma is perpetuated by eliciting the label's stereotyped narratives onto an individual or group. Within harm reduction discourse, the word "addict" can have detrimental effects on how the public perceives people experiencing addiction and their deservingness of pragmatic services. This article aims to draw attention to the inattention we give "addict" in language and explain how its routine use in society acts to perpetuate addiction stigma. Using the example of supervised injection site opposition in Canada, the use of "addict" is used as a way to understand how stigma through language works to impede the expansion of harm reduction initiatives."

Pejorative Language

  • Some words can hurt. Slurs, insults, and swears can be highly offensive and derogatory.

Articles, Websites, Blogs

2023: Names of addiction-related federal agencies are changing

  • Research has shown that reducing stigma makes it more likely that affected substance users will enter and maintain treatment.

2023: SAMHSA Eyes Budget Boost—and Cutting “Abuse” From Its Name

  • “Abuse” is an ugly word. “Child abuse,” “sexual abuse,” “physical abuse,” “emotional abuse,” “domestic abuse.” And then, of course, there’s “substance abuse.”But one of those things is not like the others: In all of the other types of abuse, there is a perpetrator who is harming a victim.


  • What Does Stigma Look Like?
    • Stigma limits a person’s ability to access services they need because they feel unworthy of receiving or requesting services.
    • Stigma creates barriers while receiving services by people feeling unwelcome or judged by program staff that offers services.

Stigmatizing Stigmas

  • "The foundation of most societal issues is rooted in hierarchies and ideologies. These two concepts are bound together by one term: stigma. Stigmas support hierarchies and give power to ideologies. Each level of any hierarchy is bound to be linked to a stigma, whether the stigma is about the people, their attitudes, mannerisms, professions, or other factors. Though often compared to their cousin, the stereotype, stigmas have much darker undertones."

Social Media

2022: Dr. Anna Maria Valdez

  • Twitter thread about hurtful ways to deal with someone trying to educate others about stigmatizing language and best practices for when being made aware of such language.

Suggestions to add to this page

2023: Curbing Physician Stigma Toward Adolescents With Nicotine and Opiate Use

2023: Why stigma matters in addressing alcohol harm

2023: A Taxonomy of Non-honesty in Public Health Communication

2022: Clive Bates at E-Cig Summit 2022

  • Ontology - Stigmatizing labels. The difference between addiction and dependence.

2017: Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care

2008: Stigma and the ethics of public health: not can we but should we