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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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“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]
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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].”
Diversity in opioid-related stigma interventions: A systematic review
Girard, R., Tomlinson, D. C., Rodriguez, C. R., Frabizio, K., Coughlin, L. N., Lin, L. A., & Spillane, N. S. (2025) · Addictive Behaviors · doi:10.1016/j.addbeh.2025.108432 · Cited by 1
Günsoy, C., Feroz, S., Kandalaft, K., & Weiss, N. H. (2025) · Current Research in Ecological and Social Psychology · doi:10.1016/j.cresp.2025.100237 · Cited by 1
“As a result, tobacco use ratios have declined significantly, while stigma against smokers has increased (e.g., Riley et al., 2017).”
Dodd, C. A., Henshall, C. L., Jain, M., & Davey, Z. (2025) · Current Oncology · doi:10.3390/curroncol33010004 · Cited by 1
“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
Socioeconomic and Healthcare Cost of Smoking
Ahamed, N. F. S., Hasan, S. I., Yasim, M. H. M., & Hairi, R. S. A. F. M. (2026) · IntechOpen eBooks · doi:10.5772/intechopen.1014530 · Cited by 1
Purposeful play: exploring a bar-based, anti-tobacco intervention for young adults
McQuoid, J., Keane, H., & Ling, P. M. (2021) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2021.1932753 · Cited by 1
“‘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).”
BackgroundOsiichuk, D. (2022) · Argumenta Oeconomica · doi:10.15611/aoe.2022.1.05 · Cited by 1
Investigating the Drivers of Smoking Cessation: A Role of Alternative Nicotine Delivery Systems?Preprint
Hampsher, S., & Prieger, J. E. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3773201 · Cited by 1
The Unrecognized Relationship Between Tax Law and Public AssistancePreprint
Rozema, K. (2018) · SSRN Electronic Journal · doi:10.2139/ssrn.3228610
Grannis, F. W. (2019) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2018.12.019
Health Campaigns: Policy Impact
Lindstadt, C., & Yanovitzky, I. (2022) · The International Encyclopedia of Health Communication · doi:10.1002/9781119678816.iehc0757
Message testing intentions to administer naloxone
Wygonik, Q. R., Glassman, T., Na, L., & Tucker‐Gail, K. (2024) · International Journal of Health Promotion and Education · doi:10.1080/14635240.2024.2438962
“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).”
Swoboda, C. M., Aldrich, A. M., Walker, D. M., & McAlearney, A. S. (2025) · Public Health · doi:10.1016/j.puhe.2025.106005
Massey, Z. B., Ibe, C., Smith, M. A., Vogel, E. A., Thrasher, J. F., & Hammond, D. G. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103306
“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
Auriol, C., Raynal, P., Preaubert, A., & Cantisano, N. (2026) · Journal of Health Psychology · doi:10.1177/13591053261417030
“…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
Karras, E., Radwan, C. K., Arriola, N. B., McCarten, J. M., Besterman‐Dahan, K., & Stecker, T. A. (2026) · Crisis · doi:10.1027/0227-5910/a001056
Auriol, C. (2024) · theses.fr (ABES) · doi:10.70675/d152f933z7bdcz45f1za506zb45f633b9d82
Metadata
- 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 › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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