A qualitative review of tobacco research related to public and structural stigma.

An informed dialog on the role of denormalization and/or stigma in tobacco control requires data. The purpose of this review is to summarize current research on public stigma and structural sources of stigma (such as policies and regulations). We conducted a systematic search of the literature in 2015. Multiple reviewers screened studies for eligibility. Inclusion criteria included: having tobacco-related stigma as a major focus; presenting original data; publication in peer-reviewed journals. Twenty-six of 325 articles met criteria for review. One reviewer tabulated study approach/design, country, population studied, number of participants, and definition of stigma used. Multiple reviewers categorized articles by type of stigma examined. Our review found that some smokers experience self-stigma such as self-loathing and shame as a result of public stigma. The few studies on structural interventions suggest that they affect some smokers in counterproductive ways, such as eliciting defiance and/or prompting public and self-stigma. Definitions of stigma, outcome measures, and study designs varied widely across studies. Public stigma occurs, resulting in positive responses such as quit attempts but also counterproductive responses. Importantly, no studies examine stigma-related impact of newer structural interventions, such as higher insurance premiums or worksite policies to employ only nonsmokers. To advance the field, it will be critical to pinpoint whether, when, and how denormalization becomes stigmatization. Employing common theories, definitions, and outcome measures could enhance research generalizability. Removing the stigmatizing aspects of existing approaches, and creating new interventions that avoid stigmatizing smokers, may help further enhance the reach and effectiveness of tobacco control. (PsycINFO Database Record (c) 2018 APA, all rights reserved)