Shaming Smokers Can Backfire


 
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By Susan Kitchens

Can smokers be “shamed” into kicking the habit?

Research from UCLA’s psychology department shows that stigmatizing smokers not only fails to keep them from lighting up, it increases their urge to smoke.

“This study provides evidence suggesting that messages intended to reduce and prevent negative behaviors by stigmatizing them could backfire,” says study co-author Clarissa Cortland, who was a Ph.D. student in psychology at UCLA when the research was conducted and is now a postdoctoral researcher at Insead.

The results have implications beyond just tobacco independence, says Marc Potenza, a professor of psychiatry at Yale School of Medicine who wasn’t involved in the study. “The area of stigmatization is important for addictions, as well as many other health concerns,” he says. “Understanding how different interventions, including public-health messages, or stigmatizing names that are applied to conditions, may result in shame or other negative consequences is very important.”

In their study, the UCLA researchers first established a baseline performance level for all participants—77 adults between the ages of 18 and 55 who smoked at least 10 cigarettes a day and had no desire to quit—in terms of their ability to refrain from smoking. Each participant was presented with eight cigarettes of his or her favorite brand, a lighter and an ashtray and offered nominal monetary awards the longer they were able to resist smoking during separate 50- and 60-minute sessions in which they were left alone.

They were brought back another day to perform the same exercise, but in addition to the smoking task, about half of the group was also randomly exposed to negative stereotypes culled from previous antismoking campaigns. The group was told that researchers were interested in the differences between smokers and nonsmokers in terms of traits such as willpower, laziness, weakness and responsibility. A control group, meanwhile, was given only a neutral message about their participation in the study: “Today you will work on a number of different tasks.” All of the subjects then participated in sessions in which they were given cigarettes with the option to smoke or not.

The researchers found that, when controlling for baseline performance on the smoking task, participants exposed to the stigmatizing messages lighted up sooner, on average, than participants in the control group.

After 20 minutes, about 70% of the participants who received stigmatizing messages had started smoking, compared with about 40% of the control group. At 40 minutes, nearly all participants exposed to stigmatizing messages had smoked, while about 20% of the control group continued to refrain.

One reason for this outcome could be attributed to a psychological phenomenon known as stereotype threat, in which people are so anxious about being identified in a negative way that they end up confirming the behaviors they are trying so hard to disprove, says Dr. Cortland. “Research suggests this happens because the worries and fears people have in these situations consume their mental efforts and distract them from performing at their best to counteract the negative stereotypes,” she says.

Health-care professionals say the study underscores their experience. “Half the battle of tobacco dependence is first removing the stigma associated with smoking” among patients who have long lost trust in a system that looks down on them for being unable to simply quit, says Panagis Galiatsatos, a pulmonologist and director of the Johns Hopkins Tobacco Treatment Clinic who wasn’t involved in the study. “I tell my patients I’m pro-smoker, antismoking,” he says.

 
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