J. DRUG EDUCATION, Vol. 21 (2) 167-182, 1991
THE STIGMATIZATION OF SMOKERS: AN EMPIRICAL INVESTIGATION*
JAY GOLDSTEIN University of Manitoba, Winnipeg
ABSTRACT
This study examines the social stigmatization of tobacco smokers, i.e., the extent to which smokers are seen as discredited persons. A representative sample of residents of a major Canadian city was interviewed. Clear evidence of an unfavorable stereotype of smokers was found. The ex-smoker enjoys a positive image, but one which is slightly less favorable than that of someone who has never smoked. A majority of non-smoking respondents preferred non-smokers in roles in which the role incumbents were likely to be in close proximity. Friendship networks and marital relationships tended to be segregated along lines of smoking behavior. Sociodemographic and attitudinal correlates of anti-smoker attitudes are explored. The implications of stigmatization for changing smokers’ behavior are examined.
Troyer and Markle have commented that cigarette smoking represents a major exception to the North American trend of increasing tolerance of behaviors (e.g., divorce and homosexuality) once considered reprehensible [1, p. 61. As a result of growing concerns about its effects on health, smoking is formerly acceptable behavior which is being put “back in the closet,” with potentially damaging consequences for the social identity and social relations o f smokers.
+Thisstudy was supported by a research grant from the Manitoba Health Research Council.
167
0 1991,Baywood Publishing Co.,Inc.
doi: 10.2190/Y71P-KXVJ-LR9H-H1MG http://baywood.com
168 / GOLDSTEIN
THE CONCEPT OF STIGMA Goffman described a stigma as an attribute which deeply discredits the individual who possesses it [2, pp. 2-31. A stigma, then, is a trait on the basis of which others impute some failing or shortcoming to its possessor. Goffman [2, pp. 4-51 identified three fundamental types of stigmas: “abominations of the body”, e.g., physical deformities such as blindness or paralysis; “blemishes of individual character” such as weak will or dishonesty, which are inferred from knowledge of an individual’s involvement in disapproved of behavior (such as alcoholism or crime), and “tribal” stigmas which arise from membership in a disvalued ethnic or religious group. A variety of imperfections are imputed to the stigmatized person on the basis of hisher original “fault” [2, p. 51. Thus, the stereotype of (Le., socially shared beliefs concerning) a stigmatized category or group is predominantly unfavorable. This negative stereotype leads “normals” (i.e., persons perceived as not having the discrediting attribute) to avoid contact with stigmatized persons. When interaction between normals and bearers of a stigma does occur, often it is highly stressful for both parties [3, pp. 113-114; 4, pp. 124-1271. Goffman used the term “courtesy stigma” to denote the symbolic contamination of a normal due to hisher associating with a stigmatized person [2, p. 301. The fear of acquiring a courtesy stigma can lead a normal individual to terminate hisher interaction with a stigmatized person. Stigmatized individuals often are subject to discriminatory (differential) treatment (e.g., denial of employment, exclusion from friendship groups, etc.). Such treatment reduces the stigmatized person’s life chances relative to those of a normal [2, p. 51. It must be noted that stigmas are relative to time and place [2, 31. An attribute which is a stigma in one social setting.may be quite desirable in another. Over a period of time, an attribute which was stigmatized may become perceived as normal, and vice versa [5]. Cigarette smoking exemplifies a behavior which recently has become stigmatized.
SMOKING AS A STIGMA: AN OVERVIEW OF THE EVIDENCE At the end of the 19th century and the beginning of the 20th century, cigarette smoking was a disreputable activity in North America [l].Male cigarette smokers were seen as effeminate, while female smokers were perceived as morally “l00se.” Any form of tobacco use was believed to corrupt the morals of minors, and laws were passed prohibiting youths’ from acquiring tobacco products. During WWI, the use of cigarettes by men was legitimized [l, pp. 40-411. By the 193Os, smoking by women had become tolerated. During the 1940s and 1950s,smoking further was transformed from a permissible act to a desirable one [1,p. 471.
STlGMATlZATlONOF SMOKERS / 169
Since the early 1960s (when Health and Welfare Canada and the US.SurgeonGeneral cited smoking as a major cause of lung cancer and other illnesses), attitudes toward smoking have changed. Surveys showed that by the end of the 197Os, a majority of Americans believed that smoking harmed the smoker’s health (1, pp. 60-61; 6, p. 2711. More recently, scientific data linking environmental tobacco smoke (“passive smoking”) to illnesses among non-smokers [7l have persuaded a substantial majority of non-smokers that cigarette smoke is hazardous to their health [6, pp. 218-2191. There is evidence that as opinions about smoking have become less favorable, cigarette smokers have become a stigmatized category. For example, Troyer and Markle [ l , p. 551, using annoyance with smokers’ behavior as an indicator of stigmatization, found that the percentage of Americans agreeing that it is annoying to be near a person who is smoking rose from roughly 45 percent in the early 1960s to nearly 65 percent a decade later. Elkind found that female nursing students in Great Britain assigned unfavorable traits to female smokers, while female non-smokers were seen in a favorable light [8]. American survey data showing that a majority of smokers were frequently or occasionally uncomfortable about smoking in public [6, p. 2191 are consistent with the assertion that stigmatized individuals feel uncomfortable in the presence of normals [2]. Differential treatment often accompanies stigmatization. Employment is one area in which smokers have experienced reduced life chances. Personnel managers have been found to prefer non-smokers over equally qualified smokers when assessing applicants for executive positions [9]. In Canada, neither federal nor provincial human rights laws protect smokers from discrimination, and some employers have made being a non-smoker a hiring requirement. The stigmatized individual usually develops a strategy for coping with the negative effects of hisher stigma. Collective efforts by members of a stigmatized category to protect their rights also can arise [lo, pp. 51-53]. An example of a collective effort was the formation of the Smoker’s Freedom Society, in 1986, by some Canadian smokers (aided financially by the three major tobacco companies in Canada). The president of the Smoker’s Freedom Society was concerned that “smoking has become equivalent to an antisocial act,” and he stated that a principal goal of his organization was to “restore the respectability of smoking” [111. RESEARCH PROBLEM While evidence points to the fact that smoking (once again) has become a stigma, there has been little systematic analysis either of the features of this stigma, or of how being a smoker might affect interaction with normals (i.e., non-smokers). This study examined four facets of the stigmatization of smokers. First, the study investigated the stereotype of the cigarette smoker. Since stigmatization is associated with the development of unfavorable beliefs about those
170 / GOLDSTEIN
who possess the undesirable attribute, it was expected that the image of smokers would be less favorable than that of persons who do not smoke. Second, in order to gain insight into the existence of negative attitudes toward smokers, the study looked at the extent to which individuals express a preference for non-smokers rather than smokers in a variety of social relationships. One consequence of stigmatization can be ostracism by normals. Thus the third facet examined was the extent to which smokers and non-smokers are involved in segregated primary (i.e., personal) relationships. Fourth, the study examined the stereotype of the former smoker (i.e., the ex-smoker). Goffman noted that in some cases, the stigmatized person can try to correct hisher failing (e.g., an obese person going on a diet). However, such attempts to create a “normal” self may be only partially successful P, P. 91. Where such repair is possible, what often results is not the acquisition of a fully normal status, but a transformation of self from someone with a particular blemish into someone with a record of having corrected a particular blemish.
The ex-smoker is someone who has corrected hisher objective failing. The effects of such successful “repair” on the image of the former smoker are not known. While it is possible that ex-smokers are seen to have the same traits as normals, it is also possible that such persons have an identity which is tainted by their previous disreputable behavior. In this study, a comparison of the image of an ex-smoker with that of a nonsmoker and a smoker was undertaken to gain insight into the social identity of former smokers. METHODS
Sample The data for this study were collected in conjunction with the 1989 Winnipeg Area Study (WAS). A systematic random sample of 752 addresses (excluding nursing homes and temporary residences) was selected from a computerized list of addresses compiled by the City of Winnipeg for the 1988 assessment. An additional random sample of 100 addresses was selected for use as replacements. The household was the primary sampling unit. One eligible individual was selected for in-home interviewing from each household. To be eligible for interviewing, an individual had to be a resident of the household, and at least eighteen years of age. A total of 127 households were judged to be ineligible (for reasons such as vacancy, the inability of interviewers to make contact after eight visits, respondents who were incapacitated, etc.). Thirty of these 127 ineligible households
STIGMATIZATION OF SMOKERS I 171
could not be replaced due to time constraints. The final sample thus was 722 (752 households minus the 30 that could not be replaced). Interviews were conducted in February and March, 1989. Interviews were completed in 521 households, for a completion rate of 72 percent. Characteristics of the sample in regard to sex, age, household size, home ownership, and neighborhood were compared with those with previous WAS samples, and with data from the 1986 Census of Winnipeg. Such comparisons indicated that the sample was an accurate representation of the Winnipeg population [12, pp. 23-24]. Measurement Semantic differential evaluative adjectival scales were used to assess the stereotype of three targets: “a cigarette smoker,” “a non-smoker” (defined for respondents as someone who had never smoked cigarettes), and “an ex-smoker” (defined as someone who used to smoke but who quit some time ago). Respondents rated the three targets on six bi-polar scales: good-bad, attractive-unattractive, considerate-inconsiderate, strongwilled-weakwilled, clean-dirty, and healthyunhealthy. The scales good-bad, attractive-unattractive, and considerate-inconsiderate tapped general evaluative traits. The scale strongwilled-weakwilledwas chosen because (despite scientific evidence that a physiological dependenceon nicotine is a major cause of regular cigarette smoking [13, pp. 220-2281) a popular explanation of smoking appears to be that the smoker simply lacks the resolve to control his/her impulse to smoke. This presumed weakness of will has been a major “blemish of individual character” ascribed to the smoker. The scale clean-dirty was selected because of the image of cigarette smoke as something which contaminates both the smoker and the things that it contacts. This image seems to underlie the proliferation of “no smoking” rooms in hotels, and “no smoking” rental cars (i.e., places which have never been soiled by smoke). The healthyunhealthy scale was selected because of the growing acceptance of the belief that smoking threatens the physical well-being of the smoker. For purposes of statistical analysis, the negative pole of each scale was scored as “l”, the mid- (or neutral) point was scored as “4”, and the positive pole was scored as “7.”In the tables which follow, each scale will be identified by the adjective at its positive pole. In order to determine if there was an attitudinal preference for non-smokers over smokers, respondents were given a list of six “kinds of people”: “a next door neighbor,” “a close friend,” “a co-worker on a job,” “a spouse/partner,” “someone you hire to do some work for you,” and “a candidate for political office.” For each “kind of person,” the respondent was asked whether he/she would prefer that person to be a smoker, or a non-smoker, or whether it would make no difference if a person was a smoker or a non-smoker, or whether “it depends.”
172 / GOLDSTEIN
The actual segregation of smokers and non-smokers in primary relationships was assessed by having respondents report how many of their three closest acquaintances (excluding family members) were cigarette smokers, and, for respondents who were married or living in a commonlaw relationship, whether or not their spouse/partner currently smoked cigarettes. RESULTS Stereotypes
The mean scores on the semantic differential scales for the three targets (based
on the responses of the total sample) are shown in Table 1. Two-tailed t-tests showed that for the target “a cigarette smoker”, the mean on each of the six scales was significantly below 4.0 (i.e., the neutral point on each scale). On average, “a cigarette smoker” was seen as unhealthy, weakwilled, dirty, inconsiderate, unattractive, and bad. In contrast, on each of the six scales, the mean rating of “a non-smoker” and of “an ex-smoker” was significantly higher than 4.0. Thus, the image of “a non-smoker” and that of “an ex-smoker” was a favorable one. These results furnish strong evidence that smokers are stigmatized. Paired t-tests were used to determine whether the mean scores of the three targets differed significantly from one another on each semantic differential scale. The results of these t-tests are summarized in Table 2. As can be seen from Table 2, on each of the six scales, the mean score for “a cigarette smoker” was significantly below the means for ‘‘a non-smoker” and for
Table 1. Ratings of “A Non-Smoker,”“An Ex-Smoker,”and “A Cigarette Smoker on Semantic Differential Scales, Total Sample (N varies from 480 to 503) Target
“A non-smoker“ JP (sd)
Scale Healthy Clean Attractive Good Considerate Strongwilled ~
5.69 5.33 5.20 5.03 4.76 5.26 ~
~~
(1.48) (1.48) (1.49) (1.46) (1.65) (1.45) ~
cigarette smoker (sd)
ex-smoker (sd)
x
5.27 5.06 4.72 4.98 4.79 5.46
x
(1.77) (1.56) (1.64) (1.58) (1.66) (1.67) ~
2.53 3.23 3.37 3.38 3.28 2.82 ~~
(1.45) (1.51) (1.54) (1.53) (1.62) (1.54) ~
‘Based on a 7-point scale,with negative pole = 1, neutral = 4, and positive pole = 7.
STIGMATIZATION OF SMOKERS / 173
Table 2. Results of &Tests of Differences Between Mean Semantic Differential Scale Ratings of “A Non-Smoker,”“An Ex-Smoker,” and “A Cigarette Smoker,”Total Sample Scale
Healthy Clean Attractive Good Considerate Strongwilled
Difference Between Mean Ratings of Targets8 Non Non Non Non Non Ex
Ex > S Ex > S > Ex > S Ex > S = Ex > S > Non > S >b
>
.Target: Non = ‘A non-smoker,“ Ex = ‘An ex-smoker,”S = ‘A cigarette smoker.” b> indicates that difference between targets is significant at or beyond the .05 level. = ‘ indicates that difference between targets is not statistically significant.
“an ex-smoker.” These findings demonstrate that cigarette smokers are evaluated less favorably than persons who had never smoked and also less favorably than “reformed” smokers. In regard to the stereotype of “an ex-smoker,” Table 1 showed that both “a non-smoker” and “an ex-smoker” were rated favorably on all six scales. It can be seen from Table 2 that “a non-smoker” and “an ex-smoker” were rated as equally good and considerate. However, “a non-smoker” was judged to be slightly healthier, cleaner, and more attractive than “an ex-smoker.” On the other hand, “an ex-smoker” was rated as slightly more strongwilled than “a non-smoker.” While these findings suggest that smoking cessation can result in a major improvement in the former smoker’s social identity, the ex-smoker appears to be slightly tarnished by hisiher previous behavior. In order to see if the image of the three targets varied according to the respondents’own smoking behavior, mean scale scores were calculated separately for the smokers and non-smokers in the sample.’ It is evident from the Part A of Table 3 that the non-smoking respondents had an unfavorable image of “a cigarette smoker”: on all of the scales, the non-smoking respondents’ mean rating of “a cigarette smoker” was significantly below 4.0. The non-smoking respondents had a positive image of both “a non-smoker” and “an ex-smoker:” on all scales, the mean rating of these targets was significantly above 4.0. The stigmatization of smokers by persons who do not smoke is quite apparent.
Respondentswho reported they had never smoked cigarettes(41 percent of the sample) and those who said they were ex-cigarette smokers (25 percent) were categorized as non-smokers. Respondents who were daily or occasional cigarette smokers (26 percent and 7 percent, respectively)or exclusively cigarkipe smokers (0.8percent) were categorized as smokers.
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Table 3. Mean Ratings of “A Non-Smoker, “An Ex-Smoker,” and ”A Cigarette Smoker“ on Semantic Dcerential Scales by Respondents’ Smoking Behavior Scale
Targef (Meanb) A: Non-Smoking Respondents (n = 31 1 to 331)
Healthy Clean Attractive Good Considerate Strongwilled
Non (5.72) Non (5.40) Non (5.39) Non (5.14) Non (5.11)
Ex (5.31)
>’ > > zd
= =
Ex (5.10) Ex (5.11) Ex (4.79) Ex (4.98) Ex (5.03) Non (5.22)
>
s (2.23)
> > >
S (2.97) s (3.09) s (3.22) S (2.91) S (2.75)
>
>
B: Smoking Respondents (n = 162 to 167) Healthy Clean Attractive Good Considerate Strongwilled
Non (5.65) Non (5.15) Non (4.91) Ex (4.97) Ex (4.34) Ex (5.75)
= = >
= > >
Ex (5.61) Ex (4.96) Ex (4.60) Non (4.81) Non (4.15*) Non (5.29)
> > > >
= >
s (3.04) s (3.68) s (3.W) S (3.69) s (3.94*) S (2.94)
‘Target: Non = “A non-smoker,”Ex = “An ex-smoker,“ S = “A cigarette smoker.” bBasedon a 7-point scale, with negative pole = 1, neutral = 4, and positive pole = 7. ‘> indicates that difference between targets is significant at or beyond the .05 level. d= indicates that differences between targets is not statistically significant. Wean not significantly different from neutral.
Part B of Table 3 shows the ratings of the targets by the smoking respondents. Since the mean score for “a cigarette smoker” on the scales attractive-unattractive and considerate-inconsiderate did not differ significantly from 4.0, these traits were not part of the smoking respondents’stereotype of “a cigarette smoker.” On all other scales, the mean rating of “a cigarette smoker” by the smokers was significantly below 4.0. Thus, while the smoking respondents ascribed fewer traits to “a cigarette smoker,” all of the traits that were part of their stereotype of this category were negative ones (i.e., “a cigarette smoker” was unhealthy, dirty, bad, and weakwilled). This result indicates that smokers have internalized much of the negative stereotype of their category. Like their non-smoking counterparts, the smoking respondents had a positive image both of “a non-smoker” and of an “ex-smoker.” All of the means for those two targets that differed significantly from 4.0 were toward the positive pole. The data in Table 3 reveal that smoker’s and non-smokers had different ideas about the effects of smoking cessation on the individual’s identity. To the smoking
STlGMATlZATlONOF SMOKERS I 175
respondents, smoking cessation eliminates most of the discreditable traits of “a cigarette smoker.” To the smoking respondents, someone who had quit smoking was significantly more considerate and strongwilled than “a non-smoker,” and equally healthy, clean, and good. This favorable image of “an ex-smoker” was not entirely shared by non-smoking respondents. As mentioned previously, the nonsmokers viewed a reformed smoker as somewhat less healthy, less clean, and less attractive than someone who had never smoked. Preferencesfor Smokers or Non-Smokers The extent to which respondents had a preference for smokers or non-smokers in six roles is shown in Table 4. Two conclusions can be drawn from that table. First, the salience of another’s smoking behavior varied among the different roles. Thus, while two-thirds (66 percent) or all respondents had some preference regarding a spouse/partner, only about one-fifth (22 percent) cared about the smoking behavior of a next-door neighbor. The second conclusion is that when smoking behavior mattered, the respondents overwhelmingly preferred a nonsmoker to a smoker. In Table 5, preferences are broken down by the respondents’ smoking behavior. The chi square probability values in Table 5 show that for each of the roles investigated, respondents’ own smoking behavior and their preferences were significantly related. In four roles (spouse/partner, co-worker, close friend, and a hired person), a substantial majority (at least 60percent) of the non-smoking respondents preferred a non-smoker. While most non-smoking respondents were indifferent to the smoking behavior of a political candidate and a next-door neighbor, nearly one-third of them preferred a non-smoker in these roles.
Table 4. Preferences for a Non-Smoker or a Smoker in Six Roles, Total Sample (N varies from 517 to 521) Expressed Preference Role Spouselpartner Co-worker Hired person Close friend Political candidate Next-door neighbor
Prefer Non-Smoker
Prefer Smoker
64.4 50.9 47.8 45.3 25.4 21.1
2.1 2.9 1.2 1.9 0.4 1.3
It Makes No Depends Difference
5.4
7.7 13.1 5.6 5.2 3.6
28.0 38.5 38.0 47.2 69.0 73.9
Total 100.0 100.0 100.0 100.0 100.0 100.0
2
A
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Spouse/partner
Co-worker
Hired person
Close friend
Polit. candidate
Neighbor
Role
29.4 5.2
31.O 15.0
61.5 13.3
60.3 23.1
68.1 17.3
82.4 29.1
Respondent's Smoking Prefer Behavior Non-Smoker
0.3 3.5
0.3 0.6
0.6 4.6
0.0 2.9
0.6 6.9
0.9 4.7
Prefer Smoker
4.7 1.7
5.3 4.6
5.2 5.2
13.4 12.1
7.1 9.2
4.1 7.6
It Depends
100.0 100.0
24.2 66.5
65.6 89.6
63.5 79.8
32.7 76.9
100.0 100.0
100.0 100.0
100.0 100.0
100.0 100.0
100.0 100.0
12.6 58.7
26.2 61.8
Total
Makes No Difference
Expressed Preference
Table 5. Preference for a Non-Smoker or a Smoker in Six Roles by Respondent's Smoking Behavior (N varies from 339 to 343 for non-smokers and from 172 to 173 for smokers)
< ,001
< .001
< ,001
< ,001
c .001
c .001
Chi Square Significance
STIGMATIZATION OF SMOKERS I 177
Table 6. Smoking Behavior of Three Closest Acquaintances by Respondent's Smoking Behavior
No. of 3 Closest Acquaintances Who Smoke
Total
Non-Smoking Respondents N (%I
Smoking Respondents N (%I
161 (47.5) 83 (24.5) 52 (15.3) 43 (12.7)
30 (17.4) 46 (26.7)
-
339 (100.0) X = 0.93
43 (25.0)
53 (30.8)
-
172 (100.0) X = 1.69
F = 57.2 d.f = 1,509 p < .001
In the case of smoking respondents, the modal response was indifference to the smoking behavior of incumbents of the six roles. However, the minority of smokers who did have a preference were, like their non-smoking counterparts, much more likely to prefer a non-smoker to a fellow smoker. Segregation in Primary Relations Self-report data on the smoking behavior of the respondents' friends and spouse/partner provided a measure of the extent to which the primary relations of smokers and non-smokers actually were segregated. In terms of friends, respondents were asked how many of their three (3) closest acquaintances (excluding family members) smoked cigarettes. Table 6 shows that the non-smoking respondents had, on average, significantly fewer smokers among their three closest friends than did the smoking respondents (0.93versus 1.69). Friendship groups which were completely homogeneous in terms of smoking behavior were reported by over 50 percent of all respondents. Nearly one-half (48 percent) of the non-smoking respondents stated that all three of their closest friends were non-smokers, while about one-third (31 percent) of the smoking respondents reported that all three of their closest friends smoked. Those respondents who were married or cohabitating non-maritally were asked whether or not their spouse/partner currently smoked cigarettes. As shown in Table 7,nearly three-fourths (72 percent) of all the marriages and commonlaw relationships among these respondents were homogeneous in terms of smoking
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Table 7. Smoking Behavior of Respondent’s SpousePartner by Respondent’s Smoking Behavior (Married/Commonlaw Respondents Only) SpousePartner Smokes?
Non-Srnoking Respondents N (%I
YeS No
42 (19.7) 171 (80.3)
Total
213 (100.0)
Smoking Respondents N (%I 51 45
(53.1) (46.9)
~~~
96 (100.0)
Chi-square = 33.5 d.f. = 1 p < .001
behavior. Eighty percent of the non-smoking respondents had a non-smoking spouse/partner. Slightly more than one-half (53 percent) of the smoking respondents had a spouse/partner who smoked. CORRELATES OF ATTITUDES TOWARD SMOKERS
In order to shed some light on the correlation of respondents’ attitudes toward smokers, two scales were created. The Image of Smokers Scale (ISS) was the sum of a respondent’s ratings of “a cigarette smoker” on the six semantic differential scales.2 Scores on the ISS could range from a low of 6 (if a respondent chose the extreme negative pole on all six scales) to a high of 42 (if the extreme positive pole was chosen on all six scales), with a score of 24 being the mid-point of the ISS.For the entire sample, the mean ISS score was 18.9, reflecting the previously noted tendency of respondents to rate “a cigarette smoker” negatively. The second scale was the Non-smoker Preference Scale (NPS). A respondent’s NPS score was based on the number of times he/she expressed a preference for a non-smoker in the six roles investigated. Scores on the NPS could range from 0 (if a respondent did not prefer a non-smoker in any of the relationships) to 6 (if a respondent preferred a non-smoker in all of the relationships). The mean on the NPS for the entire sample was 2.54. Ibe semantic differential scale scores for “a cigarette smoker” were factor analyzed, using the maximum likelihood method for extracting factors. The rotated factor matrix showed that all six scales loaded on a single factor. This finding validates the logic of summing the individual scale scores to arrive at an ISS score.
STIGMATIZATION OF SMOKERS I 179
Seven independent variables were used in stepwise multiple regression analyses, with the ISS and the NPS as the dependent variables, The independent variables, and the rationale for their inclusion, are described below. It has been argued that opposition to smoking reflects a clash between the non-smoking lifestyle of the “middle class” (non-manual or white-collar workers), and the smoking lifestyle of the “working class” (manual or blue-collar workers) [14,1 51. In light of this argument, two socio-economic status variables were included in the analysis: the respondent’s highest level of educational attainment (less than high school = 1; high school diploma = 2; some post-secondary education = 3; a non-university post-secondary degree = 4; and a university degree = 5), and the respondent’s occupation (a dummy variable with manual [blue-collar] occupation = 1 and non-manual [white collar] occupation = 2). Coleman has suggested that fear is a factor related to the intensity of a stigma [16]. Two independent variables tapped concern about the health hazards of smoking. Both were Likert-type scales, scored from 1 (“Strongly disagree”) to 5 (“Strongly agree”): “Cigarette smoking is harmful to a smoker’s health” and “Breathing in cigarette smoke is harmful to the health of non-smokers.” Two sociodemographic independent variables were included age (in years) and gender (a dummy variable with male = 1 and female = 2). The seventh independent variable was the respondent’s current smoking behavior (a dummy variable, with smoker = 1 and nonsmoker = 2). Stepwise multiple regression analysis was used to assess the relative importance of the seven independent variables as predictors of scores on the ISS and NPS. The standardized regression coefficients (betas) in Table 8 show the strength of the association between each independent variable and the dependent variable when the effects of the other independent variables are held constant. Only two independent variables were significantly related to the IS’S: one was the belief in the harmfulness of smoking to the non-smoker (b = -.2!53), while the other was the respondent’s smoking behavior (b = -.202). In combination, these two independent variables were able to explain 14 percent (multiple ? = .140) of the total variation in ISS scores. In regard to the NPS, four variables together were able to explain about 36 percent (multiple 3 = .359) of the variation in preferences for a non-smoker. When the effects of the other variables were held constant, the best predictor of NPS scores was the respondent’s own smoking behavior (b = .378), followed by the belief in the harmfulness of smoking to the non-smoker (b = .260). These two variables together explained 34 percent (multiple 9 = .338) of the variation in NPS scores. Age and a belief in the harmfulness of smoking to the smoker were the only other independent variables that were significantly related to scores on the NPS. These latter variables added only two percent to the total explained variation in the NPS.
180 / GOLDSTEIN
Table 8. Results of Stepwise Multiple Regression Analysis of the Relationship Between Image of Smokers Scale (ISS), Non-Smoker Preference Scale (NPS), and Seven Independent Variables, for Total Sample Independent Variable
Beta
Signiticance
Dependent Variable: ISS Smoke is harmful to non-smoker Respondent is a smoker Occupation (manual vs non-manual) Sex Education Smoke is harmful to smoker Age
-.253 -.202 .064 -.a1
.021
.0001
.OOO1 NS
NS NS
-.013
NS
-.010
NS
Multiple r = .374 Multiple ? = .140 ~~
~~~
Dependent Variable: NPS Respondent is a smoker Smoke is harmful to non-smoker Age Smoking harmful to smoker Education Sex Occupation
.378
.260 .116 .lo9
.om1 .ow1 .01
.05
NS
.OH -.036
NS
-.023
NS
Multiple r = .599 Multiple ? = .359
CONCLUSION
This study has examined the stigmatization of tobacco smokers. A variety of findings pointed to the fact that smokers are a discredited social category. Semantic differential scale ratings showed that non-smokers and smokers alike had an unfavorable stereotype of a cigarette smoker. In contrast, both smokers and non-smokers had a positive image of a non-smoker and of an ex-smoker. Since only a limited number of semantic differential scales were used in this investigation, it is possible that the inclusion of additional scales might have disclosed some traits on which smokers would be favorably evaluated (and
STlGMATlZATlON OF SMOKERS / 181
possibly more favorably evaluated that the other targets). However, the fact that both the non-smoking respondents and the smoking respondents tended to rate “a cigarette smoker” unfavorably on such basic evaluative traits as good-bad, and clean-dirty, suggests that it is improbable that the negative image of smokers found here simply reflects a biased selection of semantic differentials cales. The existence of unfavorable attitudes toward smokers was revealed by the fact that it was extremely rare for the smoking respondents, and even rarer still for the non-smoking respondents, to express a preference for a smoker in the six roles examined. Non-smoking respondents’ were most likely to prefer a non-smoker in primary relationships (close friend and spouse/parlner) and in work-related roles (co-worker and a hired person). These are roles characterized by face-to-face interaction, and, therefore, are ones in which a non-smoker’s concern with the unpleasant and/or harmful effects of exposure to tobacco smoke would be maximized. Behaviorally, there was clear evidence that primary relationships (friendships and marriages/common-law relationships) were segregated by smoking behavior. Such results also are consistent with the hypothesis that smokers are stigmatized. One implication of these findings is that some smokers (especially those who are have a strong need for social approval) may be motivated to alter their behavior (e.g., by refraining from smoking in public, or by quitting entirely) in order to avoid being stigmatized. However, it must be recognized that if social rejection increases, then those smokers who continue to smoke are likely to become more committed to their behavior. Discrimination against smokers by non-smokers would tend to foster a sense of solidarity among smokers that is absent today. Since cohesive groups of smokers would tend to provide reinforcement for the act of smoking, the emergence of such groups would represent an obstacle to efforts to change the smoker’s behavior. A second implication of this study pertains to influence which non-smokers can have on their smoking peers. The peer group is a setting in which informal rewards and punishments can be used to promote smoking cessation. However, the effectiveness of the peer group as an agent of change may be undermined by the success which the antismoking movement has had in getting environmental tobacco smoke defined as a serious threat to the non-smoker’s health. As this study has shown, the belief that tobacco smoke is harmful to non-smokers was the best predictor of a negative image of smokers, and the second best predictor of a preference for non-smokers. If this belief leads non-smokers to avoid informal contact with their smoking peers, then it will increase the already existing segregation of smokers. If this occurs, then the effectiveness of peer pressure as a means of promoting smoking cessation will be lessened. Paradoxically, the antismoking movement’s efforts to persuade non-smokers of the dangers of environmental tobacco smoke may be counterproductive to the movement’s efforts to get smokers to quit.
182 / GOLDSTEIN
REFERENCES 1. R. 1. Troyer and G. E. Markle, Cigarettes: The Battle Over Smoking, Rutgers University Press, New Brunswick, New Jersey, 1983. 2. E. Goffman, Stigma: Notes on the Management of Spoiled Identity, Anchor, Garden City, New York, 1%3. 3. J. Crocker and N. Lutsky, Stigma and the Dynamics of Social Cognition, in The Dilemma OfDifference,S . C. Ainlay et al. (eds.), Plenum, New York, pp.95-121,1986. 4. F. X.Gibbons, Stigma and Interpersonal Relationships, in The Dilemma of Difference, S. C. Ainlay, et al. (eds.), Plenum, New York, pp. 123-144,1986. 5. S. C.Ainley, L M.Coleman, and G. Becker, Stigma Reconsidered, in The Dilemma of Difference, S. C. Ainley et al. (eds.), Plenum, New York, pp. 1-13,1986. 6. R. H. Miles, Coffin Nails and Corporate Strategies, Prentice-Hall, Englewood Cliffs, New Jersey, 1982. 7. J. C. Byrd, R. S. Shapiro, and D. Schiedermayer, Passive Smoking: A Review of Medical and Legal Issues, American Journal of Public Health, 79, p. 209,1989. 8. A. K.Elkind, The Social Definition of Women’s Smoking Behaviour, Social Science Medicine, 20, p. 1269,1985. 9. GLOBE AND MAIL, Advice to the Ambitious: Butt Out, October 4,1986. 10. G. Becker and R. Arnold, Stigma as a Social and Cultural Construct, in The Dilemma of Difference, S . C. Ainley, et al. (eds.), Plenum, New York, pp. 39-57,1986. 11. GLOBE AND MAIL. Tobacco Firms Give Funds for Fight, September 4,1986. 12. R. F. Currie, Selected Findings from the 1989 Winnipeg Area Study, WinnipegArea Study Research Report No. 26, Department of Sociology, University of Manitoba, Winnipeg, 1989. 13. E. M.Brecher, Licit and Illicit Drugs, Little, Brown, Toronto, 1972. 14. P. L Berger, A Sociological View of the Antismoking Phenomenon, in Smoking and Society, R. D. Tollison (ed.), Heath, Toronto, pp. 225-240,1986. 15. P. F. Hadaway and B. L Beyerstein, Then They Came for the Smokers But I Didn’t Speak Up Because I Wasn’t a Smoker: Legislation and Tobacco Use, Canadian Psychology, 28, p. 259, 1987. 16. L. M. Coleman, Stigma: An Enigma Demystified, in The Dilemma of Difference, S. C . Ainley, et al. (eds.), Plenum, New York, pp. 211-232,1986.
Direct reprint requests to: Jay Goldstein Department of Sociology University of Manitoba Winnipeg, Manitoba, Canada
R3T 2N2
THE STIGMATIZATION OF SMOKERS: AN EMPIRICAL INVESTIGATION*
JAY GOLDSTEIN University of Manitoba, Winnipeg
ABSTRACT
This study examines the social stigmatization of tobacco smokers, i.e., the extent to which smokers are seen as discredited persons. A representative sample of residents of a major Canadian city was interviewed. Clear evidence of an unfavorable stereotype of smokers was found. The ex-smoker enjoys a positive image, but one which is slightly less favorable than that of someone who has never smoked. A majority of non-smoking respondents preferred non-smokers in roles in which the role incumbents were likely to be in close proximity. Friendship networks and marital relationships tended to be segregated along lines of smoking behavior. Sociodemographic and attitudinal correlates of anti-smoker attitudes are explored. The implications of stigmatization for changing smokers’ behavior are examined.
Troyer and Markle have commented that cigarette smoking represents a major exception to the North American trend of increasing tolerance of behaviors (e.g., divorce and homosexuality) once considered reprehensible [1, p. 61. As a result of growing concerns about its effects on health, smoking is formerly acceptable behavior which is being put “back in the closet,” with potentially damaging consequences for the social identity and social relations o f smokers.
+Thisstudy was supported by a research grant from the Manitoba Health Research Council.
167
0 1991,Baywood Publishing Co.,Inc.
doi: 10.2190/Y71P-KXVJ-LR9H-H1MG http://baywood.com
168 / GOLDSTEIN
THE CONCEPT OF STIGMA Goffman described a stigma as an attribute which deeply discredits the individual who possesses it [2, pp. 2-31. A stigma, then, is a trait on the basis of which others impute some failing or shortcoming to its possessor. Goffman [2, pp. 4-51 identified three fundamental types of stigmas: “abominations of the body”, e.g., physical deformities such as blindness or paralysis; “blemishes of individual character” such as weak will or dishonesty, which are inferred from knowledge of an individual’s involvement in disapproved of behavior (such as alcoholism or crime), and “tribal” stigmas which arise from membership in a disvalued ethnic or religious group. A variety of imperfections are imputed to the stigmatized person on the basis of hisher original “fault” [2, p. 51. Thus, the stereotype of (Le., socially shared beliefs concerning) a stigmatized category or group is predominantly unfavorable. This negative stereotype leads “normals” (i.e., persons perceived as not having the discrediting attribute) to avoid contact with stigmatized persons. When interaction between normals and bearers of a stigma does occur, often it is highly stressful for both parties [3, pp. 113-114; 4, pp. 124-1271. Goffman used the term “courtesy stigma” to denote the symbolic contamination of a normal due to hisher associating with a stigmatized person [2, p. 301. The fear of acquiring a courtesy stigma can lead a normal individual to terminate hisher interaction with a stigmatized person. Stigmatized individuals often are subject to discriminatory (differential) treatment (e.g., denial of employment, exclusion from friendship groups, etc.). Such treatment reduces the stigmatized person’s life chances relative to those of a normal [2, p. 51. It must be noted that stigmas are relative to time and place [2, 31. An attribute which is a stigma in one social setting.may be quite desirable in another. Over a period of time, an attribute which was stigmatized may become perceived as normal, and vice versa [5]. Cigarette smoking exemplifies a behavior which recently has become stigmatized.
SMOKING AS A STIGMA: AN OVERVIEW OF THE EVIDENCE At the end of the 19th century and the beginning of the 20th century, cigarette smoking was a disreputable activity in North America [l].Male cigarette smokers were seen as effeminate, while female smokers were perceived as morally “l00se.” Any form of tobacco use was believed to corrupt the morals of minors, and laws were passed prohibiting youths’ from acquiring tobacco products. During WWI, the use of cigarettes by men was legitimized [l, pp. 40-411. By the 193Os, smoking by women had become tolerated. During the 1940s and 1950s,smoking further was transformed from a permissible act to a desirable one [1,p. 471.
STlGMATlZATlONOF SMOKERS / 169
Since the early 1960s (when Health and Welfare Canada and the US.SurgeonGeneral cited smoking as a major cause of lung cancer and other illnesses), attitudes toward smoking have changed. Surveys showed that by the end of the 197Os, a majority of Americans believed that smoking harmed the smoker’s health (1, pp. 60-61; 6, p. 2711. More recently, scientific data linking environmental tobacco smoke (“passive smoking”) to illnesses among non-smokers [7l have persuaded a substantial majority of non-smokers that cigarette smoke is hazardous to their health [6, pp. 218-2191. There is evidence that as opinions about smoking have become less favorable, cigarette smokers have become a stigmatized category. For example, Troyer and Markle [ l , p. 551, using annoyance with smokers’ behavior as an indicator of stigmatization, found that the percentage of Americans agreeing that it is annoying to be near a person who is smoking rose from roughly 45 percent in the early 1960s to nearly 65 percent a decade later. Elkind found that female nursing students in Great Britain assigned unfavorable traits to female smokers, while female non-smokers were seen in a favorable light [8]. American survey data showing that a majority of smokers were frequently or occasionally uncomfortable about smoking in public [6, p. 2191 are consistent with the assertion that stigmatized individuals feel uncomfortable in the presence of normals [2]. Differential treatment often accompanies stigmatization. Employment is one area in which smokers have experienced reduced life chances. Personnel managers have been found to prefer non-smokers over equally qualified smokers when assessing applicants for executive positions [9]. In Canada, neither federal nor provincial human rights laws protect smokers from discrimination, and some employers have made being a non-smoker a hiring requirement. The stigmatized individual usually develops a strategy for coping with the negative effects of hisher stigma. Collective efforts by members of a stigmatized category to protect their rights also can arise [lo, pp. 51-53]. An example of a collective effort was the formation of the Smoker’s Freedom Society, in 1986, by some Canadian smokers (aided financially by the three major tobacco companies in Canada). The president of the Smoker’s Freedom Society was concerned that “smoking has become equivalent to an antisocial act,” and he stated that a principal goal of his organization was to “restore the respectability of smoking” [111. RESEARCH PROBLEM While evidence points to the fact that smoking (once again) has become a stigma, there has been little systematic analysis either of the features of this stigma, or of how being a smoker might affect interaction with normals (i.e., non-smokers). This study examined four facets of the stigmatization of smokers. First, the study investigated the stereotype of the cigarette smoker. Since stigmatization is associated with the development of unfavorable beliefs about those
170 / GOLDSTEIN
who possess the undesirable attribute, it was expected that the image of smokers would be less favorable than that of persons who do not smoke. Second, in order to gain insight into the existence of negative attitudes toward smokers, the study looked at the extent to which individuals express a preference for non-smokers rather than smokers in a variety of social relationships. One consequence of stigmatization can be ostracism by normals. Thus the third facet examined was the extent to which smokers and non-smokers are involved in segregated primary (i.e., personal) relationships. Fourth, the study examined the stereotype of the former smoker (i.e., the ex-smoker). Goffman noted that in some cases, the stigmatized person can try to correct hisher failing (e.g., an obese person going on a diet). However, such attempts to create a “normal” self may be only partially successful P, P. 91. Where such repair is possible, what often results is not the acquisition of a fully normal status, but a transformation of self from someone with a particular blemish into someone with a record of having corrected a particular blemish.
The ex-smoker is someone who has corrected hisher objective failing. The effects of such successful “repair” on the image of the former smoker are not known. While it is possible that ex-smokers are seen to have the same traits as normals, it is also possible that such persons have an identity which is tainted by their previous disreputable behavior. In this study, a comparison of the image of an ex-smoker with that of a nonsmoker and a smoker was undertaken to gain insight into the social identity of former smokers. METHODS
Sample The data for this study were collected in conjunction with the 1989 Winnipeg Area Study (WAS). A systematic random sample of 752 addresses (excluding nursing homes and temporary residences) was selected from a computerized list of addresses compiled by the City of Winnipeg for the 1988 assessment. An additional random sample of 100 addresses was selected for use as replacements. The household was the primary sampling unit. One eligible individual was selected for in-home interviewing from each household. To be eligible for interviewing, an individual had to be a resident of the household, and at least eighteen years of age. A total of 127 households were judged to be ineligible (for reasons such as vacancy, the inability of interviewers to make contact after eight visits, respondents who were incapacitated, etc.). Thirty of these 127 ineligible households
STIGMATIZATION OF SMOKERS I 171
could not be replaced due to time constraints. The final sample thus was 722 (752 households minus the 30 that could not be replaced). Interviews were conducted in February and March, 1989. Interviews were completed in 521 households, for a completion rate of 72 percent. Characteristics of the sample in regard to sex, age, household size, home ownership, and neighborhood were compared with those with previous WAS samples, and with data from the 1986 Census of Winnipeg. Such comparisons indicated that the sample was an accurate representation of the Winnipeg population [12, pp. 23-24]. Measurement Semantic differential evaluative adjectival scales were used to assess the stereotype of three targets: “a cigarette smoker,” “a non-smoker” (defined for respondents as someone who had never smoked cigarettes), and “an ex-smoker” (defined as someone who used to smoke but who quit some time ago). Respondents rated the three targets on six bi-polar scales: good-bad, attractive-unattractive, considerate-inconsiderate, strongwilled-weakwilled, clean-dirty, and healthyunhealthy. The scales good-bad, attractive-unattractive, and considerate-inconsiderate tapped general evaluative traits. The scale strongwilled-weakwilledwas chosen because (despite scientific evidence that a physiological dependenceon nicotine is a major cause of regular cigarette smoking [13, pp. 220-2281) a popular explanation of smoking appears to be that the smoker simply lacks the resolve to control his/her impulse to smoke. This presumed weakness of will has been a major “blemish of individual character” ascribed to the smoker. The scale clean-dirty was selected because of the image of cigarette smoke as something which contaminates both the smoker and the things that it contacts. This image seems to underlie the proliferation of “no smoking” rooms in hotels, and “no smoking” rental cars (i.e., places which have never been soiled by smoke). The healthyunhealthy scale was selected because of the growing acceptance of the belief that smoking threatens the physical well-being of the smoker. For purposes of statistical analysis, the negative pole of each scale was scored as “l”, the mid- (or neutral) point was scored as “4”, and the positive pole was scored as “7.”In the tables which follow, each scale will be identified by the adjective at its positive pole. In order to determine if there was an attitudinal preference for non-smokers over smokers, respondents were given a list of six “kinds of people”: “a next door neighbor,” “a close friend,” “a co-worker on a job,” “a spouse/partner,” “someone you hire to do some work for you,” and “a candidate for political office.” For each “kind of person,” the respondent was asked whether he/she would prefer that person to be a smoker, or a non-smoker, or whether it would make no difference if a person was a smoker or a non-smoker, or whether “it depends.”
172 / GOLDSTEIN
The actual segregation of smokers and non-smokers in primary relationships was assessed by having respondents report how many of their three closest acquaintances (excluding family members) were cigarette smokers, and, for respondents who were married or living in a commonlaw relationship, whether or not their spouse/partner currently smoked cigarettes. RESULTS Stereotypes
The mean scores on the semantic differential scales for the three targets (based
on the responses of the total sample) are shown in Table 1. Two-tailed t-tests showed that for the target “a cigarette smoker”, the mean on each of the six scales was significantly below 4.0 (i.e., the neutral point on each scale). On average, “a cigarette smoker” was seen as unhealthy, weakwilled, dirty, inconsiderate, unattractive, and bad. In contrast, on each of the six scales, the mean rating of “a non-smoker” and of “an ex-smoker” was significantly higher than 4.0. Thus, the image of “a non-smoker” and that of “an ex-smoker” was a favorable one. These results furnish strong evidence that smokers are stigmatized. Paired t-tests were used to determine whether the mean scores of the three targets differed significantly from one another on each semantic differential scale. The results of these t-tests are summarized in Table 2. As can be seen from Table 2, on each of the six scales, the mean score for “a cigarette smoker” was significantly below the means for ‘‘a non-smoker” and for
Table 1. Ratings of “A Non-Smoker,”“An Ex-Smoker,”and “A Cigarette Smoker on Semantic Differential Scales, Total Sample (N varies from 480 to 503) Target
“A non-smoker“ JP (sd)
Scale Healthy Clean Attractive Good Considerate Strongwilled ~
5.69 5.33 5.20 5.03 4.76 5.26 ~
~~
(1.48) (1.48) (1.49) (1.46) (1.65) (1.45) ~
cigarette smoker (sd)
ex-smoker (sd)
x
5.27 5.06 4.72 4.98 4.79 5.46
x
(1.77) (1.56) (1.64) (1.58) (1.66) (1.67) ~
2.53 3.23 3.37 3.38 3.28 2.82 ~~
(1.45) (1.51) (1.54) (1.53) (1.62) (1.54) ~
‘Based on a 7-point scale,with negative pole = 1, neutral = 4, and positive pole = 7.
STIGMATIZATION OF SMOKERS / 173
Table 2. Results of &Tests of Differences Between Mean Semantic Differential Scale Ratings of “A Non-Smoker,”“An Ex-Smoker,” and “A Cigarette Smoker,”Total Sample Scale
Healthy Clean Attractive Good Considerate Strongwilled
Difference Between Mean Ratings of Targets8 Non Non Non Non Non Ex
Ex > S Ex > S > Ex > S Ex > S = Ex > S > Non > S >b
>
.Target: Non = ‘A non-smoker,“ Ex = ‘An ex-smoker,”S = ‘A cigarette smoker.” b> indicates that difference between targets is significant at or beyond the .05 level. = ‘ indicates that difference between targets is not statistically significant.
“an ex-smoker.” These findings demonstrate that cigarette smokers are evaluated less favorably than persons who had never smoked and also less favorably than “reformed” smokers. In regard to the stereotype of “an ex-smoker,” Table 1 showed that both “a non-smoker” and “an ex-smoker” were rated favorably on all six scales. It can be seen from Table 2 that “a non-smoker” and “an ex-smoker” were rated as equally good and considerate. However, “a non-smoker” was judged to be slightly healthier, cleaner, and more attractive than “an ex-smoker.” On the other hand, “an ex-smoker” was rated as slightly more strongwilled than “a non-smoker.” While these findings suggest that smoking cessation can result in a major improvement in the former smoker’s social identity, the ex-smoker appears to be slightly tarnished by hisiher previous behavior. In order to see if the image of the three targets varied according to the respondents’own smoking behavior, mean scale scores were calculated separately for the smokers and non-smokers in the sample.’ It is evident from the Part A of Table 3 that the non-smoking respondents had an unfavorable image of “a cigarette smoker”: on all of the scales, the non-smoking respondents’ mean rating of “a cigarette smoker” was significantly below 4.0. The non-smoking respondents had a positive image of both “a non-smoker” and “an ex-smoker:” on all scales, the mean rating of these targets was significantly above 4.0. The stigmatization of smokers by persons who do not smoke is quite apparent.
Respondentswho reported they had never smoked cigarettes(41 percent of the sample) and those who said they were ex-cigarette smokers (25 percent) were categorized as non-smokers. Respondents who were daily or occasional cigarette smokers (26 percent and 7 percent, respectively)or exclusively cigarkipe smokers (0.8percent) were categorized as smokers.
174 / GOLDSTEIN
Table 3. Mean Ratings of “A Non-Smoker, “An Ex-Smoker,” and ”A Cigarette Smoker“ on Semantic Dcerential Scales by Respondents’ Smoking Behavior Scale
Targef (Meanb) A: Non-Smoking Respondents (n = 31 1 to 331)
Healthy Clean Attractive Good Considerate Strongwilled
Non (5.72) Non (5.40) Non (5.39) Non (5.14) Non (5.11)
Ex (5.31)
>’ > > zd
= =
Ex (5.10) Ex (5.11) Ex (4.79) Ex (4.98) Ex (5.03) Non (5.22)
>
s (2.23)
> > >
S (2.97) s (3.09) s (3.22) S (2.91) S (2.75)
>
>
B: Smoking Respondents (n = 162 to 167) Healthy Clean Attractive Good Considerate Strongwilled
Non (5.65) Non (5.15) Non (4.91) Ex (4.97) Ex (4.34) Ex (5.75)
= = >
= > >
Ex (5.61) Ex (4.96) Ex (4.60) Non (4.81) Non (4.15*) Non (5.29)
> > > >
= >
s (3.04) s (3.68) s (3.W) S (3.69) s (3.94*) S (2.94)
‘Target: Non = “A non-smoker,”Ex = “An ex-smoker,“ S = “A cigarette smoker.” bBasedon a 7-point scale, with negative pole = 1, neutral = 4, and positive pole = 7. ‘> indicates that difference between targets is significant at or beyond the .05 level. d= indicates that differences between targets is not statistically significant. Wean not significantly different from neutral.
Part B of Table 3 shows the ratings of the targets by the smoking respondents. Since the mean score for “a cigarette smoker” on the scales attractive-unattractive and considerate-inconsiderate did not differ significantly from 4.0, these traits were not part of the smoking respondents’stereotype of “a cigarette smoker.” On all other scales, the mean rating of “a cigarette smoker” by the smokers was significantly below 4.0. Thus, while the smoking respondents ascribed fewer traits to “a cigarette smoker,” all of the traits that were part of their stereotype of this category were negative ones (i.e., “a cigarette smoker” was unhealthy, dirty, bad, and weakwilled). This result indicates that smokers have internalized much of the negative stereotype of their category. Like their non-smoking counterparts, the smoking respondents had a positive image both of “a non-smoker” and of an “ex-smoker.” All of the means for those two targets that differed significantly from 4.0 were toward the positive pole. The data in Table 3 reveal that smoker’s and non-smokers had different ideas about the effects of smoking cessation on the individual’s identity. To the smoking
STlGMATlZATlONOF SMOKERS I 175
respondents, smoking cessation eliminates most of the discreditable traits of “a cigarette smoker.” To the smoking respondents, someone who had quit smoking was significantly more considerate and strongwilled than “a non-smoker,” and equally healthy, clean, and good. This favorable image of “an ex-smoker” was not entirely shared by non-smoking respondents. As mentioned previously, the nonsmokers viewed a reformed smoker as somewhat less healthy, less clean, and less attractive than someone who had never smoked. Preferencesfor Smokers or Non-Smokers The extent to which respondents had a preference for smokers or non-smokers in six roles is shown in Table 4. Two conclusions can be drawn from that table. First, the salience of another’s smoking behavior varied among the different roles. Thus, while two-thirds (66 percent) or all respondents had some preference regarding a spouse/partner, only about one-fifth (22 percent) cared about the smoking behavior of a next-door neighbor. The second conclusion is that when smoking behavior mattered, the respondents overwhelmingly preferred a nonsmoker to a smoker. In Table 5, preferences are broken down by the respondents’ smoking behavior. The chi square probability values in Table 5 show that for each of the roles investigated, respondents’ own smoking behavior and their preferences were significantly related. In four roles (spouse/partner, co-worker, close friend, and a hired person), a substantial majority (at least 60percent) of the non-smoking respondents preferred a non-smoker. While most non-smoking respondents were indifferent to the smoking behavior of a political candidate and a next-door neighbor, nearly one-third of them preferred a non-smoker in these roles.
Table 4. Preferences for a Non-Smoker or a Smoker in Six Roles, Total Sample (N varies from 517 to 521) Expressed Preference Role Spouselpartner Co-worker Hired person Close friend Political candidate Next-door neighbor
Prefer Non-Smoker
Prefer Smoker
64.4 50.9 47.8 45.3 25.4 21.1
2.1 2.9 1.2 1.9 0.4 1.3
It Makes No Depends Difference
5.4
7.7 13.1 5.6 5.2 3.6
28.0 38.5 38.0 47.2 69.0 73.9
Total 100.0 100.0 100.0 100.0 100.0 100.0
2
A
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Non-smoker Smoker
Spouse/partner
Co-worker
Hired person
Close friend
Polit. candidate
Neighbor
Role
29.4 5.2
31.O 15.0
61.5 13.3
60.3 23.1
68.1 17.3
82.4 29.1
Respondent's Smoking Prefer Behavior Non-Smoker
0.3 3.5
0.3 0.6
0.6 4.6
0.0 2.9
0.6 6.9
0.9 4.7
Prefer Smoker
4.7 1.7
5.3 4.6
5.2 5.2
13.4 12.1
7.1 9.2
4.1 7.6
It Depends
100.0 100.0
24.2 66.5
65.6 89.6
63.5 79.8
32.7 76.9
100.0 100.0
100.0 100.0
100.0 100.0
100.0 100.0
100.0 100.0
12.6 58.7
26.2 61.8
Total
Makes No Difference
Expressed Preference
Table 5. Preference for a Non-Smoker or a Smoker in Six Roles by Respondent's Smoking Behavior (N varies from 339 to 343 for non-smokers and from 172 to 173 for smokers)
< ,001
< .001
< ,001
< ,001
c .001
c .001
Chi Square Significance
STIGMATIZATION OF SMOKERS I 177
Table 6. Smoking Behavior of Three Closest Acquaintances by Respondent's Smoking Behavior
No. of 3 Closest Acquaintances Who Smoke
Total
Non-Smoking Respondents N (%I
Smoking Respondents N (%I
161 (47.5) 83 (24.5) 52 (15.3) 43 (12.7)
30 (17.4) 46 (26.7)
-
339 (100.0) X = 0.93
43 (25.0)
53 (30.8)
-
172 (100.0) X = 1.69
F = 57.2 d.f = 1,509 p < .001
In the case of smoking respondents, the modal response was indifference to the smoking behavior of incumbents of the six roles. However, the minority of smokers who did have a preference were, like their non-smoking counterparts, much more likely to prefer a non-smoker to a fellow smoker. Segregation in Primary Relations Self-report data on the smoking behavior of the respondents' friends and spouse/partner provided a measure of the extent to which the primary relations of smokers and non-smokers actually were segregated. In terms of friends, respondents were asked how many of their three (3) closest acquaintances (excluding family members) smoked cigarettes. Table 6 shows that the non-smoking respondents had, on average, significantly fewer smokers among their three closest friends than did the smoking respondents (0.93versus 1.69). Friendship groups which were completely homogeneous in terms of smoking behavior were reported by over 50 percent of all respondents. Nearly one-half (48 percent) of the non-smoking respondents stated that all three of their closest friends were non-smokers, while about one-third (31 percent) of the smoking respondents reported that all three of their closest friends smoked. Those respondents who were married or cohabitating non-maritally were asked whether or not their spouse/partner currently smoked cigarettes. As shown in Table 7,nearly three-fourths (72 percent) of all the marriages and commonlaw relationships among these respondents were homogeneous in terms of smoking
178 / GOLDSTEIN
Table 7. Smoking Behavior of Respondent’s SpousePartner by Respondent’s Smoking Behavior (Married/Commonlaw Respondents Only) SpousePartner Smokes?
Non-Srnoking Respondents N (%I
YeS No
42 (19.7) 171 (80.3)
Total
213 (100.0)
Smoking Respondents N (%I 51 45
(53.1) (46.9)
~~~
96 (100.0)
Chi-square = 33.5 d.f. = 1 p < .001
behavior. Eighty percent of the non-smoking respondents had a non-smoking spouse/partner. Slightly more than one-half (53 percent) of the smoking respondents had a spouse/partner who smoked. CORRELATES OF ATTITUDES TOWARD SMOKERS
In order to shed some light on the correlation of respondents’ attitudes toward smokers, two scales were created. The Image of Smokers Scale (ISS) was the sum of a respondent’s ratings of “a cigarette smoker” on the six semantic differential scales.2 Scores on the ISS could range from a low of 6 (if a respondent chose the extreme negative pole on all six scales) to a high of 42 (if the extreme positive pole was chosen on all six scales), with a score of 24 being the mid-point of the ISS.For the entire sample, the mean ISS score was 18.9, reflecting the previously noted tendency of respondents to rate “a cigarette smoker” negatively. The second scale was the Non-smoker Preference Scale (NPS). A respondent’s NPS score was based on the number of times he/she expressed a preference for a non-smoker in the six roles investigated. Scores on the NPS could range from 0 (if a respondent did not prefer a non-smoker in any of the relationships) to 6 (if a respondent preferred a non-smoker in all of the relationships). The mean on the NPS for the entire sample was 2.54. Ibe semantic differential scale scores for “a cigarette smoker” were factor analyzed, using the maximum likelihood method for extracting factors. The rotated factor matrix showed that all six scales loaded on a single factor. This finding validates the logic of summing the individual scale scores to arrive at an ISS score.
STIGMATIZATION OF SMOKERS I 179
Seven independent variables were used in stepwise multiple regression analyses, with the ISS and the NPS as the dependent variables, The independent variables, and the rationale for their inclusion, are described below. It has been argued that opposition to smoking reflects a clash between the non-smoking lifestyle of the “middle class” (non-manual or white-collar workers), and the smoking lifestyle of the “working class” (manual or blue-collar workers) [14,1 51. In light of this argument, two socio-economic status variables were included in the analysis: the respondent’s highest level of educational attainment (less than high school = 1; high school diploma = 2; some post-secondary education = 3; a non-university post-secondary degree = 4; and a university degree = 5), and the respondent’s occupation (a dummy variable with manual [blue-collar] occupation = 1 and non-manual [white collar] occupation = 2). Coleman has suggested that fear is a factor related to the intensity of a stigma [16]. Two independent variables tapped concern about the health hazards of smoking. Both were Likert-type scales, scored from 1 (“Strongly disagree”) to 5 (“Strongly agree”): “Cigarette smoking is harmful to a smoker’s health” and “Breathing in cigarette smoke is harmful to the health of non-smokers.” Two sociodemographic independent variables were included age (in years) and gender (a dummy variable with male = 1 and female = 2). The seventh independent variable was the respondent’s current smoking behavior (a dummy variable, with smoker = 1 and nonsmoker = 2). Stepwise multiple regression analysis was used to assess the relative importance of the seven independent variables as predictors of scores on the ISS and NPS. The standardized regression coefficients (betas) in Table 8 show the strength of the association between each independent variable and the dependent variable when the effects of the other independent variables are held constant. Only two independent variables were significantly related to the IS’S: one was the belief in the harmfulness of smoking to the non-smoker (b = -.2!53), while the other was the respondent’s smoking behavior (b = -.202). In combination, these two independent variables were able to explain 14 percent (multiple ? = .140) of the total variation in ISS scores. In regard to the NPS, four variables together were able to explain about 36 percent (multiple 3 = .359) of the variation in preferences for a non-smoker. When the effects of the other variables were held constant, the best predictor of NPS scores was the respondent’s own smoking behavior (b = .378), followed by the belief in the harmfulness of smoking to the non-smoker (b = .260). These two variables together explained 34 percent (multiple 9 = .338) of the variation in NPS scores. Age and a belief in the harmfulness of smoking to the smoker were the only other independent variables that were significantly related to scores on the NPS. These latter variables added only two percent to the total explained variation in the NPS.
180 / GOLDSTEIN
Table 8. Results of Stepwise Multiple Regression Analysis of the Relationship Between Image of Smokers Scale (ISS), Non-Smoker Preference Scale (NPS), and Seven Independent Variables, for Total Sample Independent Variable
Beta
Signiticance
Dependent Variable: ISS Smoke is harmful to non-smoker Respondent is a smoker Occupation (manual vs non-manual) Sex Education Smoke is harmful to smoker Age
-.253 -.202 .064 -.a1
.021
.0001
.OOO1 NS
NS NS
-.013
NS
-.010
NS
Multiple r = .374 Multiple ? = .140 ~~
~~~
Dependent Variable: NPS Respondent is a smoker Smoke is harmful to non-smoker Age Smoking harmful to smoker Education Sex Occupation
.378
.260 .116 .lo9
.om1 .ow1 .01
.05
NS
.OH -.036
NS
-.023
NS
Multiple r = .599 Multiple ? = .359
CONCLUSION
This study has examined the stigmatization of tobacco smokers. A variety of findings pointed to the fact that smokers are a discredited social category. Semantic differential scale ratings showed that non-smokers and smokers alike had an unfavorable stereotype of a cigarette smoker. In contrast, both smokers and non-smokers had a positive image of a non-smoker and of an ex-smoker. Since only a limited number of semantic differential scales were used in this investigation, it is possible that the inclusion of additional scales might have disclosed some traits on which smokers would be favorably evaluated (and
STlGMATlZATlON OF SMOKERS / 181
possibly more favorably evaluated that the other targets). However, the fact that both the non-smoking respondents and the smoking respondents tended to rate “a cigarette smoker” unfavorably on such basic evaluative traits as good-bad, and clean-dirty, suggests that it is improbable that the negative image of smokers found here simply reflects a biased selection of semantic differentials cales. The existence of unfavorable attitudes toward smokers was revealed by the fact that it was extremely rare for the smoking respondents, and even rarer still for the non-smoking respondents, to express a preference for a smoker in the six roles examined. Non-smoking respondents’ were most likely to prefer a non-smoker in primary relationships (close friend and spouse/parlner) and in work-related roles (co-worker and a hired person). These are roles characterized by face-to-face interaction, and, therefore, are ones in which a non-smoker’s concern with the unpleasant and/or harmful effects of exposure to tobacco smoke would be maximized. Behaviorally, there was clear evidence that primary relationships (friendships and marriages/common-law relationships) were segregated by smoking behavior. Such results also are consistent with the hypothesis that smokers are stigmatized. One implication of these findings is that some smokers (especially those who are have a strong need for social approval) may be motivated to alter their behavior (e.g., by refraining from smoking in public, or by quitting entirely) in order to avoid being stigmatized. However, it must be recognized that if social rejection increases, then those smokers who continue to smoke are likely to become more committed to their behavior. Discrimination against smokers by non-smokers would tend to foster a sense of solidarity among smokers that is absent today. Since cohesive groups of smokers would tend to provide reinforcement for the act of smoking, the emergence of such groups would represent an obstacle to efforts to change the smoker’s behavior. A second implication of this study pertains to influence which non-smokers can have on their smoking peers. The peer group is a setting in which informal rewards and punishments can be used to promote smoking cessation. However, the effectiveness of the peer group as an agent of change may be undermined by the success which the antismoking movement has had in getting environmental tobacco smoke defined as a serious threat to the non-smoker’s health. As this study has shown, the belief that tobacco smoke is harmful to non-smokers was the best predictor of a negative image of smokers, and the second best predictor of a preference for non-smokers. If this belief leads non-smokers to avoid informal contact with their smoking peers, then it will increase the already existing segregation of smokers. If this occurs, then the effectiveness of peer pressure as a means of promoting smoking cessation will be lessened. Paradoxically, the antismoking movement’s efforts to persuade non-smokers of the dangers of environmental tobacco smoke may be counterproductive to the movement’s efforts to get smokers to quit.
182 / GOLDSTEIN
REFERENCES 1. R. 1. Troyer and G. E. Markle, Cigarettes: The Battle Over Smoking, Rutgers University Press, New Brunswick, New Jersey, 1983. 2. E. Goffman, Stigma: Notes on the Management of Spoiled Identity, Anchor, Garden City, New York, 1%3. 3. J. Crocker and N. Lutsky, Stigma and the Dynamics of Social Cognition, in The Dilemma OfDifference,S . C. Ainlay et al. (eds.), Plenum, New York, pp.95-121,1986. 4. F. X.Gibbons, Stigma and Interpersonal Relationships, in The Dilemma of Difference, S. C. Ainlay, et al. (eds.), Plenum, New York, pp. 123-144,1986. 5. S. C.Ainley, L M.Coleman, and G. Becker, Stigma Reconsidered, in The Dilemma of Difference, S. C. Ainley et al. (eds.), Plenum, New York, pp. 1-13,1986. 6. R. H. Miles, Coffin Nails and Corporate Strategies, Prentice-Hall, Englewood Cliffs, New Jersey, 1982. 7. J. C. Byrd, R. S. Shapiro, and D. Schiedermayer, Passive Smoking: A Review of Medical and Legal Issues, American Journal of Public Health, 79, p. 209,1989. 8. A. K.Elkind, The Social Definition of Women’s Smoking Behaviour, Social Science Medicine, 20, p. 1269,1985. 9. GLOBE AND MAIL, Advice to the Ambitious: Butt Out, October 4,1986. 10. G. Becker and R. Arnold, Stigma as a Social and Cultural Construct, in The Dilemma of Difference, S . C. Ainley, et al. (eds.), Plenum, New York, pp. 39-57,1986. 11. GLOBE AND MAIL. Tobacco Firms Give Funds for Fight, September 4,1986. 12. R. F. Currie, Selected Findings from the 1989 Winnipeg Area Study, WinnipegArea Study Research Report No. 26, Department of Sociology, University of Manitoba, Winnipeg, 1989. 13. E. M.Brecher, Licit and Illicit Drugs, Little, Brown, Toronto, 1972. 14. P. L Berger, A Sociological View of the Antismoking Phenomenon, in Smoking and Society, R. D. Tollison (ed.), Heath, Toronto, pp. 225-240,1986. 15. P. F. Hadaway and B. L Beyerstein, Then They Came for the Smokers But I Didn’t Speak Up Because I Wasn’t a Smoker: Legislation and Tobacco Use, Canadian Psychology, 28, p. 259, 1987. 16. L. M. Coleman, Stigma: An Enigma Demystified, in The Dilemma of Difference, S. C . Ainley, et al. (eds.), Plenum, New York, pp. 211-232,1986.
Direct reprint requests to: Jay Goldstein Department of Sociology University of Manitoba Winnipeg, Manitoba, Canada
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