Public health policies targeted at smokers may actually have the opposite effect for some people trying to quit, according to a paper which indicates that stigmatizing smoking can, in some cases, make it harder for people to quit because they become angry and defensive and the negative messages lead to a drop in self-esteem.

The findings, a review of almost 600 articles relating to smoking self-stigma, highlight the potential for negative stereotypes to backfire, especially when it comes to public health campaigns. While the evidence shows that stigmatizing smoking may prompt some individuals to quit, the authors say that health policies could instead focus on more positive strategies, reinforcing the benefits of giving up smoking rather than reiterating negative stereotypes.

One study found that 30 to 40 percent of smokers felt high levels of family disapproval and social unacceptability and 27 percent felt they were treated differently due to their smoking status. Another study found that 39 percent of smokers believed that people thought less of them.

In multiple studies, smokers used words such as "leper," "outcast," "bad person," "low-life" and "pathetic" to describe their own behavior.

The stigma surrounding smokers leads to a number of different outcomes, including relapses, increased resistance to quitting, self-induced social isolation and higher stress levels.

Other studies examined gender biases in relation to smokers, revealing that Pakistani and Bangladeshi women who smoked were seen as "shameful" and "tainted" whereas male smokers from the same culture were viewed as "macho." Another study showed that women in general regret taking up smoking more than men do.

 Rebecca Evans-Polce, postdoctoral fellow at Penn State, said the evidence shows that vulnerable groups with few coping resources would benefit from anti-smoking programs that do not stigmatize smoking but focus instead on the benefits of giving up. 

Published in Social Science&Medicine.