Fox Chase Cancer Center Researchers Examine Perceptions of Smoking Stigma Among African American/Black Populations

Charnita Zeigler-Johnson, PhD, MPH

The African American/Black community is at increased risk for morbidity and mortality from smoking-related diseases, including lung cancer, but unfortunately, when it comes to diagnosis and treatment, smoking stigma is believed to be a primary barrier to healthcare for this community.

There is limited research on the prevalence of smoking stigma among the African American/Black community, but a study published has found that this population has negative perceptions of smoking, a phenomenon that could impact patient adherence to smoking cessation programs and lung cancer screening protocols.

“Smoking stigma is pervasive in modern society, including the African American/Black population at highest risk for smoking-related mortality. This study provides a foundation and evidence for developing multilevel projects and interventions to improve healthcare, treatment adherence, and health outcomes for people who have a history of tobacco use,” said Charnita Zeigler-Johnson, PhD, MPH.

She is the lead author on the study and Associate Director of Community Outreach and Engagement at Fox Chase. She conducted the study with first author Denine R. Crittenden, PhD, MPH, of the College of Population Health at Thomas Jefferson University, and other Jefferson and Fox Chase researchers. 

“The fact that stigma can affect individuals in multiple ways over a lifetime and can have lasting effects, even after a person has stopped smoking, indicates how important it is to reduce stigma in order to increase opportunities for prevention and early detection among high-risk populations and early treatment among patients who experience morbidity,” she said.

Zeigler-Johnson added that further studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and lung cancer screening protocols.

“We hope to develop interventions that will leverage informed social networks to better support patients with a smoking history and counter multi-level barriers of stigma,” she said.

For the study, researchers at Fox Chase and Thomas Jefferson University conducted interviews with a sample of 58 African American/Black participants in the Philadelphia region using the free-listing method, in which individuals were asked to list all thoughts and feelings regarding smoking and health-related questions.

Additionally, researchers collected self-reported demographic data for participants. Graphical methods were then used to determine significant patterns of responses across groups that were categorized by gender, age, education, and smoking status.

The sample had a median age of 51 years and was 67.2% female. Many participants had completed college (58.6%) and had never smoked (74.1%). The study indicated that among all participants, perceptions of people who smoke cigarettes showed that “smelly,” “health hazard,” and “judgment” were the most relevant terms used.

Phrases such as “unhealthy” and “addictive” were noteworthy for participants over 51 years old versus “smelly” for younger participants. The terms “smelly” and “annoying” were most common among people who smoke as opposed to “health hazard” among people who do not smoke.

“While having a smoking history may motivate some individuals to seek care, other individuals may be hindered by the presence of stigmatizing beliefs and/or actions and policies,” said Zeigler-Johnson.

The study, “Perceptions of Smoking Stigma Among African Americans: A Qualitative Study,” was published the journal Nicotine & Tobacco Research.