Confessions of an Outcast: How Heavy Smokers React to Social Norms and Policies around Smoking

Background: Efforts to decrease tobacco use among smokers in the United States include strategies to denormalize smoking, including increasing the cost of tobacco products and limiting smoking in public and private areas. Previous studies have shown that, as a result of these efforts, smokers may experience stigma related to the policies or social norms. While there are studies describing smokers' experience with tobacco denormalization efforts, few studies focus specifically on long-term, heavy smokers. The purpose of this study is to describe heavy smokers' experiences of and reactions to the social norms and policies around smoking. Methods: In June 2009, we conducted twelve, 2-hour, gender-specific focus groups with 105 “heavy smokers” as defined by smoking the equivalent of at least 1 pack of cigarettes per day for 20 years. Inductive qualitative research methods were used to analyze focus group transcripts. Results: While participants stated these policies are effective in reducing their own of cigarettes smoked, they also experienced stigmatization. Participants' reactions to this stigma included anger, shame, and feelings of lack of support in their own cessation attempts. Additionally, participants experienced this stigmatization at multiple levels including the interpersonal, systems, and community levels. Conclusion: While anti-smoking policies and strategies have been effective in decreasing smoking rates, they can inadvertently result in social norms that stigmatize smokers themselves. This, in turn, may hinder the cessation efforts of heavy smokers. Messaging around smoking cessation policies should consider this paradox.