Smoking stigma in partying young adults

Objective: Researchers characterize smoking stigma as a simultaneous tool for and impediment to public health. Stigma is defined as stereotyping and discrimination related to behavior, such as smoking cigarettes. Little is known about smoking stigma and its impact on young adults in social contexts like bars and clubs. Methods: Novel stigma assessment items were developed measuring secrecy and guilt based on validated stigma scales. We collected survey (n=205) and focus-group data in New York City, Nashville, Tucson, San Francisco and Los Angeles in 2012 from young adults (age 18-30) recruited from bars. Focus groups were coded and qualitatively assessed for stigma-related themes. Results: Over half (51.2%) of respondents reported they don't feeling guilty smoking and don't keep their smoking a secret. Smoking stigma was lowest in Tuscon (guilt=2.08, secrecy=1.80), and highest for LA (guilt=2.25, secrecy=2.63). Smokers perceived less stigma than nonsmokers, as did individuals living in houses with fewer smoking restrictions. In focus groups, participants reported a “huge separation” between smokers, perceived to be young, accepting bar-goers, and non-smokers. Participants also kept their smoking a secret from individuals highly invested in their health – doctors and family. Bar environments, location, smoker identity and stigma interacted in complex ways, affecting when and where participants smoked or identified themselves as smokers. Discussion: Smoking stigma influences who young people disclose their smoking status to, and cities with longstanding tobacco control initiatives may engender higher stigma. Public health campaigns and policies that increase smoker stigma may decrease disclosure of smoking among young adults.