Stuber Jennifer, Galea Sandro, Link Bruce G
University of Washington, Seattle, WA, USA.
Soc Sci Med. 2008 Aug;67(3):420-30. doi: 10.1016/j.socscimed.2008.03.010. Epub 2008 May 16.
An increase in the social unacceptability of smoking has dramatically decreased tobacco use in the USA. However, how policies (e.g., smoke free air laws) and social factors (e.g., social norms) drive the social unacceptability of tobacco use are not well understood. New research suggests that the stigmatization of smokers is an unrecognized force in the tobacco epidemic and could be one such mechanism. Thus, it is important to investigate the sources of smoker-related stigmatization as perceived by current and former smokers. In this study, we draw on the broader literature about stigma formation in the context of the tobacco epidemic and examine the role of attribution, fear, tobacco control policies, power and social norms in the formation of smoker-related stigma. We test hypotheses about the determinants of stigma using a population-based sample of 816 current and former smokers in New York City. The results show that perceptions of individual attributions for smoking behavior and fear about the health consequences of second hand smoke are important influences on smoker-related stigmatization. Structural forms of discrimination perpetrated against smokers and former smokers (e.g., company policies against hiring smokers) are also related to smoker-related stigma. Respondents with more education perceive more smoker-related stigma than respondents with less education and, Black and Latino respondents perceive less smoker-related stigma than White respondents. Social norms, specifically family and friends' expressed disapproval of smoking, contribute to the formation of smoker-related stigma. These findings suggest important points of leverage to harness the powerful role of stigma in the smoking epidemic and raise concerns about the possible role of stigma in the production of smoking disparities.
吸烟在社会上的可接受度降低，这已使美国的烟草使用量大幅下降。然而，政策（如无烟空气法）和社会因素（如社会规范）如何推动烟草使用在社会上变得不可接受，目前还没有得到很好的理解。新的研究表明，对吸烟者的污名化是烟草流行中一股未被认识到的力量，可能就是这样一种机制。因此，调查当前吸烟者和曾经吸烟者所感受到的与吸烟者相关的污名化的来源很重要。在本研究中，我们借鉴了关于烟草流行背景下污名形成的更广泛文献，并考察了归因、恐惧、烟草控制政策、权力和社会规范在与吸烟者相关的污名形成中的作用。我们使用纽约市816名当前吸烟者和曾经吸烟者的基于人群的样本，对污名的决定因素进行了假设检验。结果表明，对吸烟行为的个人归因认知以及对二手烟健康后果的恐惧，是对与吸烟者相关的污名化的重要影响因素。针对吸烟者和曾经吸烟者的结构性歧视形式（如公司不雇佣吸烟者的政策）也与与吸烟者相关的污名有关。受教育程度较高的受访者比受教育程度较低的受访者感受到更多与吸烟者相关的污名，黑人和拉丁裔受访者比白人受访者感受到的与吸烟者相关的污名更少。社会规范，特别是家人和朋友明确表示不赞成吸烟，有助于形成与吸烟者相关的污名。这些发现表明了利用污名在吸烟流行中的强大作用的重要着力点，并引发了对污名在产生吸烟差异中可能作用的担忧。
