Smoking, stigma and tobacco 'denormalization': Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine's Stigma, Prejudice, Discrimination and Health Special Issue (67: 3).

In recent years, addictions policy has stressed the need to counteract stigmatization in order to promote public health. However, as recent observers have noted, through the widespread implementation of tobacco 'denormalization' strategies, tobacco control advocates appear to have embraced the use of stigma as an explicit policy tool. In a recent article, Ronald Bayer (2008) argues that the mobilization of stigma may effectively reduce the prevalence of smoking behaviors linked to tobacco-related morbidity and mortality and is therefore not necessarily antithetical to public health goals. This commentary takes up this question of whether stigmatizing smoking may ultimately serve the interests of public health. Through an examination of the unique contours of tobacco control policy, we suggest that stigmatizing smoking will not ultimately help to reduce smoking prevalence amongst disadvantaged smokers - who now represent the majority of tobacco users. Rather, it is likely to exacerbate health-related inequalities by limiting smokers' access to healthcare and inhibiting smoking cessation efforts in primary care settings.

Understanding the social consequences of chronic obstructive pulmonary disease: the effects of stigma and gender.

Stigma is a social construction that defines people in terms of a distinguishing characteristic or mark, and devalues them as a consequence. Stigma occurs when society labels someone as tainted, less desirable, or handicapped. There is emerging evidence that chronic obstructive pulmonary disease (COPD) is a physical condition with social consequences. The valuing, and devaluing, of individuals within society are social judgments that have roots in sociocultural values and beliefs. Cultural norms and values dictate the distinct roles and behaviors that are expected of men and women in a given culture. Social reactions to individuals with COPD can have an effect on their illness experience. This article explores the relationships between COPD and stigma and gender, particularly how these key elements may interact to affect experiences of individuals with COPD within their social milieu. The aim of this article is to begin to set out questions and issues that require further empirical exploration. The stigma of COPD arises because people are held responsible for their disease, are noted to have engaged in a stigmatized behavior (smoking), are marked with oxygen equipment and bodily changes, and experience a disruption in their social interactions.