Gendered experience of tobacco stigma: Implications for tobacco control

Tobacco denormalization has become a widely accepted tobacco control strategy, shaping policies and programs throughout the United States as well as globally. In spite of the population-level success of California’s program, smoking prevalence remains high among the most disadvantaged Californians, including some ethnic minority women. In particular smoking risk for Black women is among the highest in the state, and these women experience among the greatest risk for tobacco-related diseases.  Such persistent disparities in smoking raise questions about the extent to which tobacco denormalization strategies have been designed with diverse groups in mind. Given that tobacco denormalization strategies emphasize the stigmatization of smoking, unintended consequences may exist for some groups. For smokers who already experience discrimination as a result of other social identities -- like ethnic minority women -- the stigma that they experience from smoking may intensify the “social isolation and marginalization” that they already experience, resulting in reactions to denormalization strategies that differ from the majority. This paper discusses results from a qualitative study that investigated tobacco stigma among Black young people in the San Francisco Bay Area. Interviews revealed that perceptions of and experiences with tobacco stigma were gendered for participants, raising important questions about the effectiveness of tobacco denormalization strategies for Black women as well as about the ethics of using stigma as a tobacco control strategy.