Why campaigns that stigmatize smokers can make them want to quit even less
…Yet, little is known about how those who smoke cope with smoking-related stigma that may stem from these strategies and the negative consequences of smoking-related stigma on those who smoke. Of particular concern are the potential consequences of internalizing public stigma which is referred to as self-stigma or internalized stigma as they are likely to vary for individuals. For example, the public stigma of smoking could result in four potential outcomes for smokers. The desired outcome and the one often assumed by public health practitioners is that smokers will internalize the stigma and quit smoking in order to feel better. However, there are at least three other potential outcomes which can be detrimental: (1) the smoker internalizes the smoking stigma, loses self-esteem and self-efficacy, and fails to quit smoking, (2) the smoker resists internalizing the smoking stigma remaining indifferent and fails to quit smoking, or (3) the smoker resists smoking stigma internalization, may become angry and defensive at the public for stigmatizing smoking, fails to quit smoking and may even increase their self-esteem and self-efficacy regarding smoking.
I’ve never internalised the smoking stigma, but I’ve encountered a few people who did. Most smokers I encounter seem to fall into category (2). They don’t think less of themselves for smoking, and remain indifferent to the stigma, and carry on smoking.
I suppose that of the four responses on offer, my own is nearest to (3). I don’t internalise the stigma, and have lost no self-esteem. Instead I’ve got angry.
But not angry at “the public”. The general public don’t stigmatise smokers. In the 8 years since the introduction of the UK smoking ban, I’ve never once had anyone show the slightest sign of disapproval at seeing me smoking in a pub garden, or on the street, or in my car.
It’s not the public that’s doing the stigmatising. The people who are doing that are the people in Tobacco Control: the Deborah Arnotts and Linda Baulds and Ian Gilmores and Stanton Glantzes, who’ve somehow managed to get unrestricted access to the media to peddle their antismoking message. They’re the stigmatisers.
So the people I’m angry with are the people in Tobacco Control. And I’m not defensive about it. I’m on the attack. I’m always trying to think up ways of undermining and destroying them. Because that’s what I want to do. And I must have been a little bit effective because I’ve got my own page on the Tobaccotactics website. I’m not the only one who’s got their own page.
So really I should have a missing category (4), which would be something like:
(4) the smoker doesn’t want to quit smoking at all, is determined to carry on, resists smoking stigma internalisation, becomes very angry (“all-out F U anger” as Walt put it) at Tobacco Control for stigmatising smoking, goes on the attack with his blog, and plans to destroy the bastards.
The article is clearly written by a thoughtful antismoker (or is that an oxymoron?), because her ‘desired outcome’ is what I would regard as the ‘detrimental’ outcome. I think it’s detrimental to anybody to internalise a stigma that has been placed upon them. Stigmatising smokers is no different from stigmatising blacks, Jews, homosexuals, women, or anyone else. Even if the result of being stigmatised results in someone stopping smoking, it has been done by reducing their status, removing their dignity, and in a profound sense breaking them. The ex-smokers who have been made to stop smoking this way are broken people.
But I’m not at all sure that it’s the stigma placed on smoking that makes smokers stop smoking. Nor do I think that most smokers want to give up smoking. It’s one of the dogmas of Tobacco Control that “70% of smokers want to stop smoking”. But my impression is that 95% of them don’t want to stop smoking, or stop doing anything else they enjoy doing (drinking, eating). Why on earth should they want to stop doing something that they enjoy doing?
What happens instead, I think, is that insistent Smoking Kills messages gradually magnify smokers’ fears about disease and death, and these fears gradually come to outweigh the pleasure they take in smoking. And this is the point where their cost-benefit analysis tells them they should try to quit smoking. I think that pretty much all the smokers I’ve ever known gave up because they got worried about their health. They didn’t give up because they’d been stigmatised, because for the last 70+ years – apart from the last 10 years or so – there has been no stigma at all attached to smoking. Smokers give up smoking because they succumb to health fears promulgated by Tobacco Control, against which they have no defences. They have no defences against the massed ranks of doctors, authorities, experts, and the general consensus of opinion. They’re unable to swim against the tide.
I could say more, but that’ll do for now.