Nicotine - Stigma: Difference between revisions

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*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.
*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]
*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]
===2018: [https://psycnet.apa.org/record/2017-40480-001 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.
===2016: [https://ir.stthomas.edu/cgi/viewcontent.cgi?article=1647&context=ssw_mstrp 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.


===2008: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006698/ Smoking and the emergence of a stigmatized social status]===
===2008: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006698/ Smoking and the emergence of a stigmatized social status]===

Revision as of 09:26, 7 August 2022



File:640px-StopStigma.png


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"

Videos

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

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: 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]

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.

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.

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.

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.


Articles, Websites, Blogs

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

Housing 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 ‘Swapto-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."


"Relapse"

"Black Words - Example: Black Market"

Studies, Papers, Reports

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."


"ANTZ"

Definition

  • This is a derogatory label applied to individuals and groups focused on eliminating all nicotine and tobacco products without taking the continuum of risk into consideration. Many of those individuals believe that all forms of nicotine are harmful, and society would experience improved public health without the use of nicotine.
  • 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 faced years of stigmatization for our use of nicotine and our belief we have a right to use it. 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). #BeKind - 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 with respect, even if they've come across as rude first. #TeachByExample


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

Videos

Let's Break the Stigma

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


Studies, Papers, Reports

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.

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."


Articles, Websites, Blogs

RESPECT TO CONNECT: UNDOING STIGMA

  • 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."