How stigmatizing smoking might maintain smoking

The various actions taken to reduce smoking prevalence seem to have had some success but in the last few years there has been little change.  There are a few theories as to why this might be, and why the initial drop occurred, but the fact is that the smoking level dropped and now despite ever increasing anti-smoking regulations and anti-smoker stigma seems stable.

This could mean a number of things such as either this is a natural level of nicotine use in this society, that is that this proportion of the population really does use nicotine to improve brain function or simply to feel more at ease in their environment.  It could also mean that these are the ones who were less able to quit than the others.

But there is another possibility.

What if it is somewhat about stigma and risk.  What if the most motivating factors behind the drop were 1. education: smoking is unhealthier than you thought it was and 2. experience: having an explanation for disease you see in those close to you and 3. risk averseness: you would rather quit than possibly end up like them.

Then what about the others?

The great move to denormalize smoking took the behavior from being just something some people did, and turned it into a political act.  Everyone knew there was some health risk in smoking but that was not the dominant sense of it nor did smoking distinguish you from other members of society.  After denormalization started working, smoking became more rebellious, and the risk involved in smoking played a much larger part.

Many anti-smoking actions are supposedly aimed at reducing teen smoking.  If there is one group that embraces risk and rebellion, it is teenagers.  People later in years, many who if they smoked naturally gave it up, did so out of changing priorities; they started accruing responsibilities, some of which benefited by being healthier.  Parents tend to forgo risky activities because they risk more than just their own futures.

However, the larger context is an increasingly risk averse society.  Given the choices, smoking is a pretty mild way to assert some individuality, some small rebellion as opposed to jumping out of a plane which while having some risk is not a signifier of being anti-social.  And most of us want to swim apart at least some of the time.  Ergo smoking.

Smoking stigma may in fact maintain smoking in this helmet wearing, keep your kids inside, watch everything you eat, overly cautious present.

Which makes electronic cigarettes so interesting; you get to be anti-social without the health risks.

(And ultimately, stigmatizing is more a form of politicized whining which says a lot more about the whiners than it does about the targets).

-PLB

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2 thoughts on “How stigmatizing smoking might maintain smoking

  1. Paul,
    An interesting idea, though it might be a better case for why most every teen still *tries* smoking (and other nicotine) because it is either (a) normal, so they try it or (b) a major act of rebellion, so they try it. I am still inclined to defend the hypothesis that the number of dedicated smokers reflects the portion of the population that gets major benefits from nicotine.

    Also, I have to wonder if e-cigs really fulfill the political-statement goal. We should do some research, but I am guessing that a teen puffing on an e-cig suffers the scorn of both the kids who have been convinced to vilify all nicotine users (he is an evil druggie) and the kids who use tobacco (he is a complete geek). I think that only the anti-nicotine extremists seem to think that kids are going to be drawn to e-cigs (and, frankly, I think they just pretend to think that as an excuse for interfering with THR for reasons I have argued). Is there any evidence of kids even trying e-cigs, and if so is there any feedback out they play socially?

    [Note to other readers: Yes, Paul and I work together. But that does not mean we cannot openly debate theories and even disagree — such as about whether “unhealthier” is a word :-). Such honest disagreement distinguishes scientists and public health advocates — those of us who are trying to maximize people’s welfare, and thus need to understand people’s motives and desires — from anti-tobacco extremists who pursue simplistic goal and demand conformity to the party line.]

  2. Carl,

    Despite working together I do agree with much of what you say here.

    I did not intend this to be a definitive reason for why teenagers smoke but rather a reason. Of course, different people, and different teenagers, smoker for different reasons. It was just an idea I wanted to explore a little.

    I do very much agree with the correction of the ecig aspect though the antis are very much working at getting it perceived as anti-social as cigarette smoking. It would be a harm reduction coup if it were successfully framed as rebellious as smoking and thus competed for the rebellious “will smoke something or do some drug” teenage market, or attract those of us who never entirely outgrow that impulse.

    (I do have to admit I would never drink a light beer (despite it still filling the act of drinking, a very minor rebellion) and I tend to discount those who do).

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