Nicotine - Stigma: Difference between revisions

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**He has never smoked.

**She uses e-cigarettes.

====''Journal of the National Comprehensive Cancer Network'' (JNCCN) [https://www.nccn.org/docs/default-source/about/nccn-guidance-on-inclusive-language.pdf?sfvrsn=53c8c78f%201 NCCN Language Guidance: Sensitive, Respectful, and Inclusive Language for NCCN Publications]====

====[http://cfs.cbcs.usf.edu/publications/JBHSRAuthorguidelines.pdf ''Journal of Behavioral Health Services & Research'' (JBHS&R)]====

*Authors are expected to use "person/people first" language (e.g., "individuals with chronic mental disorders" rather than "the chronic mentally ill").

====[https://jneuroengrehab.biomedcentral.com/submission-guidelines/preparing-your-manuscript/research-articles ''Journal of NeuroEngineering and Rehabilitation'']====

====American Psychiatric Nurses Association: [https://www.apna.org/wp-content/uploads/2021/03/Tobacco_Dependence_Treatment_Position_Statement_07_20.pdf POSITION STATEMENT: Psychiatric-Mental Health Nursing’s Role in Tobacco Treatment]====

====Anesthesia Experts - [https://anesthesiaexperts.com/uncategorized/person-first-language-anesthesiology-care/ Person-First Language in Anesthesiology Care]====

*So, is person-first language objectively superior to nonperson-first language? An increasing body of research suggests that it is. Many of the diseases and conditions frequently used to stand in for a person with the condition are those in which there is an unstated or even explicit implication that lifestyle choices are responsible for the condition (alcoholic, addict, diabetic, cirrhotic) or otherwise telegraph shame directed at the patient with the diagnosis (obese, epileptic, smoker). Using person-first language promotes respect and dignity for patients. Describing someone as “a patient with diabetes” rather than “a diabetic” acknowledges that the person is more than just their illness and recognizes their individuality. Using person-first language also helps to avoid stigmatization and discrimination, which can have a negative impact on a patient’s mental and physical well-being (Diabetes Spectr 2018;31:58-64). This may be especially true for mental health conditions, substance use disorders, painful syndromes, eating or body image-related conditions, and in obstetric care (Int J Drug Policy 2010;21:202-7).

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

====Change Lab Solutions - [https://www.changelabsolutions.org/sites/default/files/2022-03/Justice-in-the-Air-Framing-Tobacco-Related-Health-Disparities_FINAL_20220307A.pdf Justice In The Air: Framing Tobacco-Related Health Disparities A FrameWorks Strategic Brief ]====

*Use person-first language. Avoid labeling people as “smokers” or “tobacco users.” Instead, start with people, then add any necessary qualifiers: people who smoke, people with a dependence on nicotine.

====NCSCT - [https://twitter.com/NCSCT/status/1727984982897910117 The National Centre for Smoking Cessation and Training]====

*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’

====NYC - [https://www.nyc.gov/assets/doh/downloads/pdf/survey/tobacco-inequities-2022.pdf Addressing New York City’s Smoking Inequities]====

*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.

====Massachusetts Down Syndrome Congress - [https://mdsc.org/programs/people-first-language/ People First Language]====

*Abstract submitters are strongly encouraged to use person-first language in their abstracts.

*The Guide is not long, dense, or difficult to understand. It encourages everyone to “take conscious steps to be thoughtful in the language we use,” and boils down to four simple, subtle principles:

**Use Person-First Language: For example, instead of “lung cancer patient,” use “patient/person with lung cancer.”

**Equity: Follow best practices regarding race, ethnicity, gender, socioeconomic, and geographic descriptions to promote cultural humility and sensitivity.

*“We came together from different places, with different methods and different training, but we all agree that words matter, and that it is possible to change the language we use to talk to and about persons with lung cancer, as well as about people who use tobacco,” Dr. Ostroff said. “And we can do that in a way that that conveys respect, inclusivity, and equity.”

===[https://media.nutrition.org/wp-content/uploads/2023/04/N23-Abstract-Presentation-Guidelines.pdf NUTRITION 2023]===

=='''Videos'''==

===2021: E-Cigarette Summit: [https://vimeo.com/572107642 Stigma and tobacco harm reduction: what we can learn from other health behaviors]===

*[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.

=='''Studies, Papers, Reports - Smoker'''==

===2022: [https://www.mdpi.com/1660-4601/19/9/5628/htm A Person-Centered Approach to Moralization—The Case of Vaping]===

===2021: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238180/ 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: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733058/ Changing the Language of How We Measure and Report Smoking Status: Implications for Reducing Stigma, Restoring Dignity, and Improving the Precision of Scientific Communication]===

===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://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]===

===2016: [https://academic.oup.com/ntr/article/18/8/1684/2492710 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]

===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042508/ Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response]===

*"For these reasons, the Editorial Team of ''Substance Abuse'' seeks to formally operationalize respect for personhood in our mission, our public relations, and our instructions to authors. To our knowledge, few journals have explicitly taken this step,7–12 and we are the first scientific addiction journal to do so. Our overarching call is threefold. First, we are asking authors to carefully and intentionally consider the language they use to describe alcohol and other drug use and disorders, the individuals affected by these conditions, and their related behaviors, comorbidities, treatment, and recovery..."

===2013: [https://irp.cdn-website.com/a4ee3539/files/uploaded/PIC_Tasmania_Report_2013.pdf 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]===

*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.

*It’s exactly that stigma that society has attached to the word—leaving little room for nuance or reinvention in the fixed, judgemental glare of a label—that’s prompting growing numbers to move away from its use.

*"While some language conventions have stagnated, others have started to move in more positive directions. For example, terms such as “diabetic” or “smoker” are being replaced with “a person living with diabetes” and “a person who uses cigarettes.” While the former terms were always clearly understood, they had the effect of defining the individuals as their disease or risk factor. The latter terms acknowledge the person first."

*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.

*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”

*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.

*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.

*'''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.'

*[https://web.archive.org/web/20230326001139/https://www.apna.org/news/psychiatric-mental-health-nursings-role-in-tobacco-treatment/ Link on WayBack Machine]

*"Ordinarily, stigmatizing a disease or observing medical practitioners making decisions based on social characteristics would raise the hackles of the public health community. With smoking, however, this hasn’t been the case. In fact, many anti-smoking campaigns actually turn to stigmatization as a behavioral control tactic."

*In 2004, a team of health scientists at Oxford interviewed 45 people with lung cancer and found that felt even more stigma than other cancer patients: Participants experienced stigma commonly felt by patients with other types of cancer, but, whether they smoked or not, they felt particularly stigmatized because the disease is so strongly associated with smoking… Some patients concealed their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people.

===[https://twitter.com/MarewaGlover/status/1719683510368424372 Prof Marewa Glover]===

===[https://twitter.com/Dana_Bourne/status/1542200997061197828 Dana Elizabeth Bourne, MPH]===

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

=='''Examples: People Who Smoke'''==

===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625812/ DOES IT HELP SMOKERS IF WE STIGMATIZE THEM? A TEST OF THE STIGMA-INDUCED IDENTITY THREAT MODEL AMONG U.S. AND DANISH SMOKERS]===

===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297009/ Smoking-Related Stigma: A Public Health Tool or a Damaging Force?]===

*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 (People Who Use Nicotine)'''==

*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).

*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.

*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: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006698/ Smoking and the emergence of a stigmatized social status]===

='''Lessons Learned: Substances, Alcohol, Incarceration, Illnesses, Disabilities, Mental Health, Weight, etc.'''=

===2023: [https://www.sciencedirect.com/science/article/abs/pii/S0889855323000869 Language Frames and Shapes the Response to Obesity]===

*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: [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]===

=='''Articles, Websites, Blogs - Language/Stigma'''==

===2023: [https://www.apaservices.org/advocacy/news/addiction-related-federal-agencies Names of addiction-related federal agencies are changing]===

*Sleep researchers may worry that adopting people-centered language will be onerous or hinder the use of elegant shorthand. However, convenience should not take priority over reducing stigma and better engaging the people this research is intended to serve.

*"These labels erased my humanity. Total strangers felt allowed to criticize or judge me, saying that I was ‘such a waste of life,’ ‘useless,’ or ‘just a drunk or addict.’ These words also carried the connotation that I was lazy, selfish, or a criminal. After a while, I began to believe these words, concluding that I no longer served a purpose, had opportunities, or deserved hope."

===[https://cmjcenter.org/wp-content/uploads/2017/07/CNUS-AppropriateLanguage.pdf The Center for NuLeadership on Urban Solutions]===

=Suggestions to add to this page=

===1987: [https://sci-hub.wf/10.1086/228672 The Social Rejection of Former Mental Patients: Understanding Why Labels Matter]===

===2022: [https://vimeo.com/showcase/9893575/video/779678704 Clive Bates at E-Cig Summit 2022]===

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

===2017: [https://pubmed.ncbi.nlm.nih.gov/28553905/ Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care]===