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Andrea Borondy Kitts
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ES13 - Global Political, Legal, and Financial Strategies For Tobacco Control (ID 16)
- Event: WCLC 2019
- Type: Educational Session
- Track: Prevention and Tobacco Control
- Presentations: 1
- Now Available
- Moderators:Desmond Carney, Esteve Fernandez
- Coordinates: 9/08/2019, 15:15 - 16:45, Vienna (2016)
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ES13.05 - Stigma and Impact of Tobacco Control Policy (Now Available) (ID 3228)
15:15 - 16:45 | Presenting Author(s): Andrea Borondy Kitts
- Abstract
- Presentation
Abstract
A simple quick google search on breast cancer people and lung cancer people is enough to show the impact of stigmatizing smoking on people with lung cancer (Figure 1). Breast cancer people are perceived as pink, young, healthy, cheerful, supportive and happy although that is not an accurate depiction of the breast cancer journey. In contrast, lung cancer people are seen as diseased and dying, sad, concerned, bleak, and alone with little support.
The stigma associated with smoking stops people from going to the doctor because they are afraid the doctor will think they are stupid for continuing to smoke, it stops people from getting screened for lung cancer because they blame themselves for smoking and feel they deserve the disease or because they are afraid their loved ones will blame them for getting sick. The stigma reduces the funding available for lung cancer research. In the US, federal funding for lung cancer research per lung cancer death is only 15% of the funding amount for breast cancer per breast cancer death.
People with lung cancer, regardless of their smoking status, encounter stigma on a regular basis.(1) Often after disclosing a lung cancer diagnosis for themselves or for a loved one the first comment is not, I’m so sorry you have this awful disease. The first comment is invariably “I didn’t know you smoked” or “Was he a smoker” or “He smoked a lot. It’s not surprising he got lung cancer” or “It’s to be expected since you are a smoker” In a Global Lung Cancer Coalition survey, one in five people (21%) agreed with the statement that they have less sympathy for people with lung cancer than for people with other types of cancer.
Studies have shown that the stigma encountered by people with lung cancer reduces quality of life, increases depression and negatively impacts outcomes.(2)
Probably most disturbing is that stigmatization of smokers has the greatest impact on the socioeconomically deprived, the disadvantaged populations.(3) These populations have the highest prevalence of smokers and encounter the stigma of their race or disadvantage (poverty, disability, sexual preference, behavioral health etc.) in addition to the stigma associated with smoking.(4)
One could argue that tobacco control (tobacco denormalization efforts) may be tolerable if they resulted in short term stigma but increase tobacco cessation for these disadvantaged populations resulting in an overall public health benefit. Unfortunately, studies show that tobacco control efforts have the least impact on socioeconomically deprived populations thus actually increasing the health inequity (and stigma) for this already marginalized population. Smoking related stigma may actually help reinforce smoking in this population by being perceived as resistance to the norms of society. In other words, tobacco control efforts may not work and may actually have the opposite effect.(5,6,7)
This stigmatization leads people who smoke to be less likely to seek medical care when they have symptoms, more likely to lie about their smoking, more likely to be refused access to care including curative surgery for early stage lung cancer unless they quit smoking, less likely to be offered smoking cessation help if they are uncomfortable disclosing their smoking status due to stigma and bias from their healthcare professional.(5,6)
Tobacco control and stigmatization of smokers has resulted in stigmatizing all people with lung cancer regardless of smoking history or socioeconomic status. It’s time to stop stigmatizing people who smoke and people with lung cancer but rather to promote and implement policies that have been shown to work in deterring tobacco use and helping people quit.(8) These include increased age limits for tobacco purchase and use, increased taxes on tobacco sales, free access to tobacco cessation counseling, nicotine replacement products and prescription smoking cessation medications.
1. Hamann HA, Howell LA, McDonald JL. “You did this to yourself”: causal attributions and attitudes toward lung cancer patients. J Appl Soc Psychol. 2013;43:E37–E45. doi:10.1111/jasp12053.
2. Cataldo, JK, & Brodsky, JL. Lung cancer stigma, anxiety, depression and symptom severity. Oncology (Switzerland). 2013;85(1):33-40. http://dx.doi.org/10.1159/000350834
3. Bell K, Salmon A, Bowers M, Bell J, McCullough L. Smoking, stigma and tobacco ‘denormalization’: Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine's Stigma, Prejudice, Discrimination and Health Special Issue (67: 3). Social Science & Medicine. 2010;70(6):795-799. https://doi.org/10.1016/j.socscimed.2009.09.060
4. Borondy Kitts AK. The patient perspective on lung cancer screening and health disparities. J Amer Coll Rad. 2019;16(4):601-606. https://doi.org/10.1016/j.jacr.2018.12.028.
5. Evans-Polce RL, Castaldelli-Maia JM, Schomerus G, Evans-Lacko SE. The downside of tobacco control? Smoking and self-stigma: A systematic review. Social Science & Medicine. 2015;145:26-34. https://doi.org/10.1016/j.socscimed.2015.09.026
6. Kirsten Bell K, Salmon A, Bowers M, Bell J, McCullough L. Smoking, stigma and tobacco ‘denormalization’: Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine's Stigma, Prejudice, Discrimination and Health Special Issue (67: 3). Social Science & Medicine. 2010; 70(6):795-799. https://doi.org/10.1016/j.socscimed.2009.09.060.
7. Lozano P, Thrasher JF, Forthofer M, Hardin J, Reynales Shigematsu LM, Santillán EA, Fleischer NL. Smoking-related stigma: A public health tool or a damaging force?, Nicotine & Tobacco Research, , nty151, https://doi.org/10.1093/ntr/nty151
8. Hill S, Amos A, Clifford D, et al. Impact of tobacco control interventions on socioeconomic inequalities in smoking: review of the evidence. Tobacco Control. 2014;23:e89-e97.
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