Decreasing smoking but increasing stigma? Anti-tobacco campaigns, public health, and Cancer care
Open accessAbstract
Public health researchers, mental health clinicians, philosophers, and medical ethicists have questioned whether the public health benefits of large-scale anti-tobacco campaigns are justified in light of the potential for exacerbating stigma toward patients diagnosed with lung cancer. Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma. We argue that there is an ethical burden for creators of public health campaigns to consider lung cancer stigma in the development and dissemination of hard-hitting anti-tobacco campaigns. We also contend that health care professionals have an ethical responsibility to try to mitigate stigmatizing messages of public health campaigns with empathic patient-clinician communication during clinical encounters.
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The trial faces four main challenges-recruitment, app engagement, outcome data retention, and remote biochemical verification-primarily because participants are in active cancer treatment.
“There are four main challenges of this trial, all of which are primarily due to the challenges of study participants being in active cancer treatment (i.e., multiple treatments and appointments, shame about being a smoker with cancer, fatigue from cancer and treatment, fatalism about the benefits of quitting):29–32,73 (1) trial recruitment; (2) app intervention engagement, (3) outcome data reten”
From Efficacy of smartphone applications to help cancer patients quit smoking: Protocol of the Quit2Heal randomized controlled trial (2023) · cites this paper as [32]
The sections “Do Hard-Hitting Anti-Tobacco Ad Campaigns Contribute to Stigma?” and “What Should be Done?” discuss stigma, shame, and guilt among patients with lung cancer. They do not identify four challenges in this trial or establish that active cancer treatment primarily causes its recruitment, app-engagement, outcome-retention, and remote-verification difficulties. Page numbers are unavailable in our copy. (LLM, conf=0.84)
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“Furthermore, both individuals who smoke and those of higher BMI face social stigmatization, which has been welldocumented in other works (Puhl and Heuer, 2010; Riley et al., 2017).”
BackgroundKaplan, D. M., Hamann, H. A., Price, S. N., Williamson, T. J., Ver Hoeve, E. S., McConnell, M. H., Duchschere, J. E., Garland, L. L., & Ostroff, J. S. (2023) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2022.2033377 · Cited by 13 · see citing works
“007, but not from pre- to mid-intervention t(18)=.”
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A systematic review of second-hand smoking mass media campaigns (2002–2022)
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“One potential consequence can include stigmatisation of those who are already smoking [102, 103].”
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“45 Interestingly, in the statistical models, age over 70 was also independently associated with a decreased likelihood of all types of stigma.”
BackgroundNarrative persuasion and stigma: Using news accounts to denormalize texting while driving.
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Self-citationEffectiveness of Public Messaging Within the Gambling Domain: A Systematic Review
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“Also, hard-hitting anti-tobacco campaigns are likely to be effective in changing attitudes and intentions toward smoking and decrease smoking rates, but they have the unintended consequences of stigmatising those affected with smoking-related illnesses (Riley et al., 2017).”
Arendse, K. D., Walter, F. M., Pilling, M. A., Zhou, Y., Hamilton, W. T., & Funston, G. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x714077 · Cited by 8 · see citing works
“39 The present finding that greater deprivation is only weakly associated with longer test–diagnostic intervals is in keeping with a recent systematic review conducted by Forrest et al. 36 Though other evidence shows that higher deprivation is associated with increased lung cancer incidence and…”
Young parents’ experiences and perceptions of ‘Teen Mom’ reality shows
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Studts, J. L., Carter‐Harris, L., Hamann, H. A., Smith, R. A., Kazerooni, E. A., Rosenthal, L. S., & for the Stigma and Nihilism Task Group of the American Cancer Society National Lung Cancer Roundtable (2025) · Cancer · doi:10.1002/cncr.35969 · Cited by 7 · see citing works
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Does ostracism help smokers quit?
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An Effort Worth Making: A Qualitative Study of How Swedes Respond to Antibiotic Resistance
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Tobacco quitlines: Opportunities for innovation to increase reach and effectiveness
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Women's Information Needs and Educational Preferences Regarding Lung Cancer Screening
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“113,115 Stigma associated with lung cancer—particularly tied to smoking history— fosters unconscious biases and discriminatory attitudes within health care settings.”
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“Particularly in BC, where mastectomies are one of its core lines of treatment, some cultures regard them as mutilating [35].”
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Quantitative Evaluation of Cancer Stigma among Non-Patient Population in Oman
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“Therefore, prevention campaigns should carefully disseminate messages, aiming for a balanced approach that enhances risk factor awareness without exacerbating stigma [19].”
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A systematic review of the factors associated with lung cancer stigma
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“61,62 The use of tailored materials employing culturally sensitive and empathic messaging is particularly important in discussions about lung cancer screening to minimize potential stigmatization of at-risk populations.”
A Multi-Disciplinary Study Into the Drivers of Smoking Cessation in South KoreaPreprint
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Does stigma reduce hazardous health behaviors contributing to steatotic liver disease?
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Self-citationAdvocacy for Global Tobacco Control and Child Health
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Implementing Evidence-Based Tobacco Treatment Interventions in Oncology to Achieve Optimal Outcomes
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“Patients with tobacco-related diseases have reported that anti-tobacco advertisements increased internalized stigma, which contributes to delayed diagnoses and worse quality of life [25].”
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“As a result, tobacco use ratios have declined significantly, while stigma against smokers has increased (e.g., Riley et al., 2017).”
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“Public awareness and education campaigns for lung cancer have traditionally focused on smoking cessation and can add to the stigma experienced by lung cancer patients [40].”
Hassantash, S., Cranford, H. M., Koru-Sengul, T., & Pinheiro, P. S. (2026) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02810-1 · Cited by 1 · see citing works
Socioeconomic and Healthcare Cost of Smoking
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Purposeful play: exploring a bar-based, anti-tobacco intervention for young adults
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“‘Hard hitting’ campaigns can contribute to stigmatizing smokers and those affected by tobacco-related diseases when attempting to eliminate smoking as a practice (Riley et al., 2017).”
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Message testing intentions to administer naloxone
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“However, such findings should be interpreted in the context of the persisting controversy in the literature regarding the use of fear appeals (Kok et al. 2017; Moussaoui, Claxton, and Desrichard 2021; Riley et al. 2017).”
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“Some scholars argue that fear-arousing health warnings in anti-tobacco campaigns may cause people who smoke to feel stigmatized (Riley et al., 2017).”
Additional file 1 of A systematic review of second-hand smoking mass media campaigns (2002–2022)
Lim, C. C. W., Rutherford, B. N., GARTNER, C. E., McClure‐Thomas, C., Foo, S., Su, F.-Y., Scheurer, R. W., Sebayang, S. K., Chan, G., Stjepanović, D., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25341100
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“…general disparity in how these behaviors are socially and morally judged, consistent with previous research indicating that tobacco use is heavily stigmatized due to its strong causal link with lung cancer and the widespread public health campaigns against smoking (Kirby, 2020; Riley et al., 2017).”
Designing Campaigns Toward Veterans at Risk for Suicide Following Separation From Military Service
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- Authors
- Riley, K. E., Ulrich, M. R., Hamann, H. A., & Ostroff, J. S.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Boston University (US)
- University of Arizona (US)
- Venue
- AMA Journal of Ethics
- Publisher
- American Medical Association (AMA)
- Published
- 2017-05-01
- Volume
- 19
- Issue
- 5
- Pages
- 475-485
- ISSN
- 1937-7010 (ISSN-L)
- 2376-6980
- PMC
- PMC5679230
- OpenAlex
- W2613943031
- Cited by
- 104
- References
- 45
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 14 · 2023: 11 · 2022: 9 · 2021: 12 · 2020: 13 · 2019: 13 · 2018: 7
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The AMA Journal of Ethic (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- bepress Legal Repository (submittedVersion, cc-by-nc-sa)
- Funders
- National Lung Cancer Partnership
- Lung Cancer Research Foundation
- Memorial Sloan-Kettering Cancer Center (T32CA009461)
- National Cancer Institute (R03CA193986, R03CA154016, P30CA008748, T32CA009461)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- anti-smoking campaigns, public health ethics, patient-clinician communication, empathic communication, tobacco control, health care ethics
- MeSH terms
- Smoking Prevention, Advertising, Health Promotion, Humans, Neoplasms, Smoking, Nicotiana, Social Stigma
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