Nicotine - Stigma: Difference between revisions
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*The NCSCT has committed to using ‘people first’ language wherever possible, so instead of ‘smoker’ we will talk about ‘people who smoke’ or just ‘people’ | *The NCSCT has committed to using ‘people first’ language wherever possible, so instead of ‘smoker’ we will talk about ‘people who smoke’ or just ‘people’ | ||
====[https://www.nice.org.uk/media/default/About/what-we-do/wg1-style-guide.docx NICE style guide ] | ====2024: [https://www.nice.org.uk/corporate/ecd1/chapter/talking-about-people NICE style guide - Talking about people]==== | ||
*[https://www.nice.org.uk/media/default/About/what-we-do/wg1-style-guide.docx NICE style guide (downloadable document)] | |||
*'''Smoker: Do not use. In line with our house style, we do not label people. Use 'people who smoke'.''' [emphasis added] | *'''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'. | *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'. | ||
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*In general, refer to the person first and the disability second. People with disabilities are, first and foremost, people. Labeling a person equates the person with a condition and can be disrespectful and dehumanizing. A person isn’t a disability, condition or diagnosis; a person has a disability, condition or diagnosis. This is called Person-First Language. | *In general, refer to the person first and the disability second. People with disabilities are, first and foremost, people. Labeling a person equates the person with a condition and can be disrespectful and dehumanizing. A person isn’t a disability, condition or diagnosis; a person has a disability, condition or diagnosis. This is called Person-First Language. | ||
*However, always ask to find out an individual’s language preferences. People with disabilities have different preferences when referring to their disability. Some people see their disability as an essential part of who they are and prefer to be identified with their disability first – this is called Identity-First Language. Others prefer Person-First Language. Examples of Identity-First Language include identifying someone as a deaf person instead of a person who is deaf, or an autistic person instead of a person with autism. | *However, always ask to find out an individual’s language preferences. People with disabilities have different preferences when referring to their disability. Some people see their disability as an essential part of who they are and prefer to be identified with their disability first – this is called Identity-First Language. Others prefer Person-First Language. Examples of Identity-First Language include identifying someone as a deaf person instead of a person who is deaf, or an autistic person instead of a person with autism. | ||
====INPUD: [https://inpud.net/words-matter-language-statement-reference-guide/ Words Matter! Language Statement & Reference Guide]==== | |||
*Recommends person-first language. | |||
*"Compiled by INPUD and the Asian Network of People who Use Drugs (ANPUD), this guide aims to explain our current position on the use of language and to provide clear advice on what is acceptable to us as communities of people who use drugs. We want to encourage all people to be thoughtful about the language and words they use, and have therefore provided a reference guide that identifies stigmatising language and gives non-judgemental, strengths-based, and respectful alternatives." | |||
====Massachusetts Down Syndrome Congress - [https://mdsc.org/programs/people-first-language/ People First Language]==== | ====Massachusetts Down Syndrome Congress - [https://mdsc.org/programs/people-first-language/ People First Language]==== | ||
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*[https://www.e-cigarette-summit.us.com/speaker/prof-scott-leischow/ Prof Scott Leischow] | *[https://www.e-cigarette-summit.us.com/speaker/prof-scott-leischow/ 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. | *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. | ||
===2017: Video: [https://vimeo.com/246425657 Sarah Jakes]=== | |||
*Ecig Summit UK | |||
===[https://vimeo.com/314638943 Let's Break the Stigma]=== | ===[https://vimeo.com/314638943 Let's Break the Stigma]=== | ||
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===2020: [https://ajph.aphapublications.org/doi/ref/10.2105/AJPH.2020.305628 Stigma, Opioids, and Public Health Messaging: The Need to Disentangle Behavior From Identity]=== | ===2020: [https://ajph.aphapublications.org/doi/ref/10.2105/AJPH.2020.305628 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 | *"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] | ||
===2020: [https://facesandvoicesofrecovery.org/wp-content/uploads/2020/06/Zgierska-2020-JAM-Language_Matters52.pdf Language Matters: It Is Time We Change How We Talk About Addiction and its Treatment]=== | ===2020: [https://facesandvoicesofrecovery.org/wp-content/uploads/2020/06/Zgierska-2020-JAM-Language_Matters52.pdf Language Matters: It Is Time We Change How We Talk About Addiction and its Treatment]=== | ||
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*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. | *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 - Stigma, Smoking, and Lung Cancer'''== | =='''Studies, Papers, Reports, Articles, Blogs, Videos, etc. - Stigma, Smoking, and Lung Cancer'''== | ||
===2025: [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841677 Age-Based Screening for Lung Cancer Surveillance in the US]=== | |||
*"Unlike risk-based lung cancer screening focused exclusively on tobacco smoking, universal breast and colorectal cancer programs have simplified access and increased participation.28 Risk-specific guidelines may deter participation by implying lifestyle blame or creating eligibility confusion, compounded by stigma." | |||
=== 2025: Article: [https://archive.ph/hvzZd The hidden reason lung cancer screening is not working]=== | |||
*By: Lisa Carter-Bawa, Ph.D., M.P.H., N.P. | |||
===2025: IASLC Podcast: [https://www.iaslc.org/iaslc-news/lung-cancer-considered/please-dont-tell-my-family-stigma-and-lung-cancer “Please Don’t Tell My Family”: Stigma and Lung Cancer]=== | |||
*Featuring: Narjust Florez MD - Lisa Carter-Bawa PhD, MPH, APRN - Jamie L. Studts PhD | |||
===2023: Article: [https://medicalxpress.com/news/2023-09-stigmatization-smoking-related-diseases-barrier-problem.html Stigmatization of smoking-related diseases is a barrier to care, and the problem may be on the rise]=== | |||
*"The study, conducted by a team of researchers led by Nathan Harrison, a behavioral scientist and Ph.D. student from Flinders University, in Australia, aimed to identify and synthesize existing interventions to combat stigma associated with lung cancer and smoking-related respiratory diseases, including chronic obstructive pulmonary disease (COPD)." | |||
===2023: Op-Ed: [https://filtermag.org/lung-cancer-vaping-misinformation/ Stigma and Misinformation Maintain the Devastating Toll of Lung Cancer]=== | |||
*By: Skip Murray | |||
===2022: [https://www.sciencedirect.com/science/article/pii/S2772628222000103 Reducing stigma triggered by assessing smoking status among patients diagnosed with lung cancer: De-stigmatizing do and don't lessons learned from qualitative interviews]=== | ===2022: [https://www.sciencedirect.com/science/article/pii/S2772628222000103 Reducing stigma triggered by assessing smoking status among patients diagnosed with lung cancer: De-stigmatizing do and don't lessons learned from qualitative interviews]=== | ||
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===2021: [https://www.lungcancercoalition.org/wp-content/uploads/2021/03/Great-Britain-national-data-pack-FINAL.pdf Great Britain: symptom awareness and attitudes to lung cancer Findings from a global study]=== | ===2021: [https://www.lungcancercoalition.org/wp-content/uploads/2021/03/Great-Britain-national-data-pack-FINAL.pdf Great Britain: symptom awareness and attitudes to lung cancer Findings from a global study]=== | ||
*One in four (25%) people in the UK agreed that they have less sympathy for people with lung cancer than other forms of cancer. Globally, one in five (21%) people agreed that they have less sympathy for people with lung cancer than other forms of cancer. | *One in four (25%) people in the UK agreed that they have less sympathy for people with lung cancer than other forms of cancer. Globally, one in five (21%) people agreed that they have less sympathy for people with lung cancer than other forms of cancer. | ||
===2018: [https://pubmed.ncbi.nlm.nih.gov/29800746/ Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum]=== | |||
*"Attention to the robust causal connection between smoking and lung cancer, although crucial for tobacco control, may have unintended consequences that generate blaming responses and biased negative perceptions toward patients with lung cancer..." | |||
===2018: Article: [https://connection.asco.org/do/helping-patients-face-lung-cancer-stigma “Please Don’t Tell My Family!”: Helping Patients Face Lung Cancer Stigma]=== | |||
*By: Narjust Florez, MD, FASCO | |||
===2017: [https://journalofethics.ama-assn.org/article/decreasing-smoking-increasing-stigma-anti-tobacco-campaigns-public-health-and-cancer-care/2017-05 Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care]=== | |||
*"Public health researchers, mental health clinicians, philosophers, and medical ethicists have questioned whether the public health benefits of large-scale anti-tobacco campaigns are justified in light of the potential for exacerbating stigma toward patients diagnosed with lung cancer. Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma. We argue that there is an ethical burden for creators of public health campaigns to consider lung cancer stigma in the development and dissemination of hard-hitting anti-tobacco campaigns. We also contend that health care professionals have an ethical responsibility to try to mitigate stigmatizing messages of public health campaigns with empathic patient-clinician communication during clinical encounters." | |||
===2015: [https://pubmed.ncbi.nlm.nih.gov/25736473/ Lung cancer stigma as a barrier to medical help-seeking behavior: Practice implications]=== | |||
*"Findings support an association between lung cancer stigma and delayed medical help-seeking behavior. Therefore, lung cancer stigma is a potential barrier to timely medical help-seeking behavior in lung cancer symptoms, which can have important patient outcome implications." | |||
===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634635/ Lung Cancer Stigma, Anxiety, Depression and Quality of Life]=== | ===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634635/ Lung Cancer Stigma, Anxiety, Depression and Quality of Life]=== | ||
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*The results of this study confirm our previous findings that LCS [lung cancer stigma] is positively correlated with anxiety and depression and negatively correlated with QOL [quality of life]. | *The results of this study confirm our previous findings that LCS [lung cancer stigma] is positively correlated with anxiety and depression and negatively correlated with QOL [quality of life]. | ||
== | ===2012: [https://link.springer.com/article/10.1186/1471-2407-12-184 A systematic review of the impact of stigma and nihilism on lung cancer outcomes]=== | ||
*"There is qualitative evidence that from the patients’ perspectives public health programs contribute to stigma about lung cancer and this was supported by published commentary." | |||
=='''Studies, Papers, Reports - Employment and/or Insurance (People Who Use Nicotine)'''== | =='''Studies, Papers, Reports - Employment and/or Insurance (People Who Use Nicotine)'''== | ||
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=='''Studies, Papers, Reports - Language/Stigma'''== | =='''Studies, Papers, Reports - Language/Stigma'''== | ||
===2024: [https://onlinelibrary.wiley.com/doi/full/10.1002/jaoc.12137 Person-first language and addiction literature: The presence of labeling and emotional language in counseling articles]=== | |||
*"The purpose of this study was to determine the rate and frequency of labeling language, emotional language, and person-first language (PFL) toward individuals with substance use disorders and addictions in articles published in 24 counseling journals. Of the 249 articles reviewed, 61.04% did not fully adhere to PFL, while 34.54% included labeling language and 51.41% included emotional language. A significant positive correlation was found between the use of labeling language and emotional language. Implications for practicing counselors, counselor educators, and researchers are provided. We advocate for the use of PFL toward those with addictions in published works and in conversations." | |||
===2024: [https://www.sciencedirect.com/science/article/pii/S2772724624000210 Substance use stigma: A systematic review of measures and their psychometric properties]=== | |||
*"Stigma, defined as societal labeling and mistreatment based on perceived differences (Link and Phelan, 2001) leads to a divisive “us” versus “them” dynamic that leads to status loss in a context of power dynamics. Substance use stigma (SUS) involves negative stereotypes and discrimination toward people that use substances, which results in limiting their access to needed resources and impeding wellbeing (Livingston et al., 2012). Stigma is pervasive in society and based out of moral judgments that substance use is bad or wrong (Room, 2005)." | |||
*"SUS significantly hinders treatment and education, adding to the burden carried by people with substance use disorders (Keyes et al., 2010, Kulesza et al., 2013). It limits access to treatment through underfunding of substance use treatment services (Saloner et al., 2014, Zemore et al., 2021, Calabrese et al., 2016, Luoma, 2010) and creates barriers to reintegrating into communities (Neale et al., 2011)." | |||
===2023: [https://www.sciencedirect.com/science/article/abs/pii/S0889855323000869 Language Frames and Shapes the Response to Obesity]=== | ===2023: [https://www.sciencedirect.com/science/article/abs/pii/S0889855323000869 Language Frames and Shapes the Response to Obesity]=== | ||
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*Creating a stigma-free health system will require collaborative action and sustained commitment of key players across the health system. | *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”. | *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: [https://gh.bmj.com/content/4/5/e001911 Why we should never do it: stigma as a behaviour change tool in global health]=== | |||
*Shame-induced stigma most damages those already vulnerable, reinforcing health disparities. | |||
*Global health use of shaming tactics can inadvertently worsen health-damaging stigma, especially for those with the least power. | |||
*These effects, that drive additional health disparities and suffering, are difficult to prevent. | |||
*Ethically and practically, stigma should never be deployed as a global health tool because the effects are often both unavoidable and invisible to outsiders. | |||
===2019: [https://www.cpha.ca/sites/default/files/uploads/resources/stbbi/language-tool-e.pdf LANGUAGE MATTERS Using respectful language in relation to sexual health, substance use, STBBIs and intersecting sources of stigma]=== | ===2019: [https://www.cpha.ca/sites/default/files/uploads/resources/stbbi/language-tool-e.pdf LANGUAGE MATTERS Using respectful language in relation to sexual health, substance use, STBBIs and intersecting sources of stigma]=== | ||
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=='''Articles, Websites, Blogs - Language/Stigma'''== | =='''Articles, Websites, Blogs - Language/Stigma'''== | ||
===2024: [https://shameandmedicine.org/what-is-the-difference-between-shame-and-stigma/ What is the Difference Between Shame and Stigma?]=== | |||
*Identifying a condition as ‘stigmatising’ can show us how living with this condition can lead to negative social experiences such as discrimination, judgement, social exclusion, vilification, ostracism, labelling, loss of status, prejudice, unfair treatment, among others. | |||
*It is important to understand shame because it is shame that drives behaviour and decision-making, and in healthcare contexts, shame can easily lead to disengagement, non-disclosure, lying, withdrawal and avoidance. | |||
===2023: [https://www.apaservices.org/advocacy/news/addiction-related-federal-agencies Names of addiction-related federal agencies are changing]=== | ===2023: [https://www.apaservices.org/advocacy/news/addiction-related-federal-agencies Names of addiction-related federal agencies are changing]=== | ||
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=Suggestions to add to this page= | =Suggestions to add to this page= | ||
===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675843/ Validity and Reliability of the Internalized Stigma of Smoking Inventory: An Exploration of Shame, Isolation, and Discrimination in Smokers with Mental Health Diagnoses]=== | |||
===2015 | |||
=== | ===2025: [https://www.linkedin.com/pulse/nonprofit-jargon-divides-here-words-use-jzsve/ Nonprofit Jargon Divides. Here Are Words to Use Instead.]=== | ||
=== | ===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC8992888/ Avoiding Ableist Language: Suggestions for Autism Researchers]=== | ||
===1987: [https://sci-hub.wf/10.1086/228672 The Social Rejection of Former Mental Patients: Understanding Why Labels Matter]=== | ===1987: [https://sci-hub.wf/10.1086/228672 The Social Rejection of Former Mental Patients: Understanding Why Labels Matter]=== | ||
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* Central to our discussion is the research literature concerned with the concept of state-paternalism in tobacco control—the line between an ethically justified interference with the freedom of those who smoke and an exaggerated infringement disproportionate to the same people’s right to live as they choose. | * Central to our discussion is the research literature concerned with the concept of state-paternalism in tobacco control—the line between an ethically justified interference with the freedom of those who smoke and an exaggerated infringement disproportionate to the same people’s right to live as they choose. | ||
* In countries with an already advanced infrastructure for tobacco control, this dilemma might become quite intrusive for regulators. We ask that if people, who smoke are aware of and have accepted the risks, are willing to pay the price, smoke exclusively in designated areas, and make decisions uninfluenced by persuasive messages from manufacturers—is a further tightening of anti-smoking measures still legitimate? | * In countries with an already advanced infrastructure for tobacco control, this dilemma might become quite intrusive for regulators. We ask that if people, who smoke are aware of and have accepted the risks, are willing to pay the price, smoke exclusively in designated areas, and make decisions uninfluenced by persuasive messages from manufacturers—is a further tightening of anti-smoking measures still legitimate? | ||
** Conclusion: We recommend that a further intensification of smoking control in countries that already have a | ** Conclusion: We recommend that a further intensification of smoking control in countries that already have a well-developed policy in this area requires that regulators start to exploit the opportunity that lies in the ongoing diversification of the recreational nicotine market. | ||
* Karl Erik Lund and Gunnar Saebo; Harm Reduction Journal (2024) 21:33https://doi.org/10.1186/s12954-024-00951-w | * Karl Erik Lund and Gunnar Saebo; Harm Reduction Journal (2024) 21:33https://doi.org/10.1186/s12954-024-00951-w | ||
* Funding: Norwegian Institute of Public Health (Governmental) | * Funding: Norwegian Institute of Public Health (Governmental) | ||
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===2023: [https://academic.oup.com/cid/article/76/10/1860/7016316 Call to Action: Prioritizing the Use of Inclusive, Nonstigmatizing Language in Scientific Communications]=== | ===2023: [https://academic.oup.com/cid/article/76/10/1860/7016316 Call to Action: Prioritizing the Use of Inclusive, Nonstigmatizing Language in Scientific Communications]=== | ||
===2023: [https://www.psychiatrist.com/pcc/addiction/substance-use-disorders/curbing-physician-stigma-toward-adolescents-with-nicotine-opiate-use/ Curbing Physician Stigma Toward Adolescents With Nicotine and Opiate Use]=== | ===2023: [https://www.psychiatrist.com/pcc/addiction/substance-use-disorders/curbing-physician-stigma-toward-adolescents-with-nicotine-opiate-use/ Curbing Physician Stigma Toward Adolescents With Nicotine and Opiate Use]=== | ||
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===2022: [https://vimeo.com/showcase/9893575/video/779678704 Clive Bates at E-Cig Summit 2022]=== | ===2022: [https://vimeo.com/showcase/9893575/video/779678704 Clive Bates at E-Cig Summit 2022]=== | ||
*Ontology - Stigmatizing labels. The difference between addiction and dependence. | *Ontology - Stigmatizing labels. The difference between addiction and dependence. | ||
===2014: [https://www.amjmed.com/article/S0002-9343(14)00770-0/fulltext Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States]=== | ===2014: [https://www.amjmed.com/article/S0002-9343(14)00770-0/fulltext Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States]=== | ||
===2008: [https://pubmed.ncbi.nlm.nih.gov/18502551/ Stigma and the ethics of public health: not can we but should we]=== | ===2008: [https://pubmed.ncbi.nlm.nih.gov/18502551/ Stigma and the ethics of public health: not can we but should we]=== | ||