# Perceptions of Smoking Stigma Among African Americans: A Qualitative Study

## TL;DR

This study explores how African Americans perceive smoking stigma, finding that it is linked to negative social and health-related judgments.

## Contribution

The study provides new insights into smoking-related stigma among African Americans, a population underrepresented in prior research.

## Key findings

- Terms like 'smelly,' 'health hazard,' and 'judgment' were most commonly associated with smoking stigma among African Americans.
- Stigma was linked to negative social interactions, social judgment, and health concerns across age, gender, and education levels.
- Smoking-related stigma was more prevalent among non-smokers compared to current smokers.

## Abstract

African Americans/Blacks (AAB) are at increased risk for morbidity and mortality from smoking-related diseases including lung cancer (LC). Smoking stigma is believed to be a primary barrier to health care-seeking for people who smoke. Previous studies illustrate that perceptions of smoking vary across populations. However, little is known about the prevalence of smoking stigmas among AAB. The purpose of this study was to increase understanding of the perception of cigarette smoking by AAB.

We conducted free-listing interviews in which individuals listed all-thoughts and feelings regarding smoking and health-related questions with a convenience sample of eligible AAB adults (n = 58) in the Philadelphia region. Additionally, we collected participant self-reported demographic data. Data were cleaned and the salience of each term was computed using Anthropac. Graphical methods were then used to determine salient responses across groups stratified by gender, age, education, and smoking status.

The sample had a median age of 51 years and was 67.2% female. Most participants had completed college (58.6%) and had never smoked (74.1%). Regarding their perceptions of people who smoke cigarettes, results showed that “smelly,” “health hazard,” and “judgment” were the most salient terms among all-participants. Overall, “smelly” and “unhealthy” were salient for both males and females. However, “dental,” “dirty,” “addictive,” and “habit” were also salient among males. Phrases such as “unhealthy” and “addictive” were primarily salient for older participants (>51 years) versus “smelly” for younger participants. The term “smelly” was salient among all-education levels. However, “unhealthy” was also salient among those with less than a 4-year college degree. Moreover, the terms “smelly” and “annoying” were most common among people who smoke as opposed to “health hazard” among people who don’t smoke.

We observed that the most stigmatizing language was primarily associated with perceptions of negative social interactions, social judgment, and health-related concerns. Future studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and LC screening protocols.

Little is known about the prevalence of smoking stigmas among AAB. This study explores the AAB perspective of cigarette smoking and related stigmas. Among AAB, smoking is represented by stigmatizing language across gender, age groups, and smoking history. It is primarily associated with negative social interactions, social judgement, and health-related concerns indicating that smoking stigma is a concern for AAB individuals who smoke. Further research is warranted.