Substance use disorder is one of the most stigmatized health conditions. Stigma internalization is one of the main consequences of the stigmatization process, and it is associated with lower self-esteem and self-efficacy and worse recovery prospects. It may also bring guilt, hopelessness, anxiety, self-devaluation, and depression. This study investigated self-stigma among substance dependents who sought treatment, testing the construction of a psychosocial model for understanding this phenomenon. Individual interviews were conducted at the Psychosocial Care Center for Alcohol and Drugs at Juiz de Fora, Brazil. Data were subjected to exploratory statistical analysis, using descriptive and standard deviation. Three explanatory models of self-stigma were tested: the sociodemographic model, including variables such as gender, religious practice, education, marital status, employment status, and involvement in illicit activities; the psychological model, with variables related to symptoms of depression, self-esteem, and hope; and the psychosocial model, which included all sociodemographic and psychological variables. The sample was composed by 461 individuals. The results supported the hypothesis that the psychosocial model would have greater explanatory power of self-stigma among substance dependents. An association between self-stigma and the sociodemographic variables and the type of substance used was confirmed. Depressive symptoms contributed to higher scores on self-stigma. Stigma may be a barrier to access to health care, treatment, social research, social inclusion, and recovery opportunities. Interventions and treatment models that are able to reduce self-stigma would have the potential to contribute toward a reduction in the negative impacts associated with substance use disorder.

Resumo: Aplicativos de smartphones estão sendo desenvolvidos como uma forma complementar ao tratamento do tabagismo. O presente estudo teve como objetivo analisar o conteúdo de aplicativos disponíveis na língua portuguesa em dois sistemas operacionais: Android e iOS. Cinquenta e um aplicativos foram encontrados no iTunes e 600 no Google Play. Foram incluídos na avaliação do conteúdo aqueles aplicativos que tivessem como foco a cessação do tabagismo, com um total de 12 no iOS e 3 no Android. Cada aplicativo foi categorizado por meio da sua abordagem na cessação de tabagismo e pontuado de acordo com o seu nível de aderência às diretrizes de tratamento de tabagismo do Treating Tobacco Use and Dependence. Em relação às categorias, 9 foram classificados como calendário, 8 como informativo, 6 como calculadora, 3 como medidor de cigarros fumados e 1 como hipnose. Os aplicativos apresentaram baixo nível de aderência às diretrizes, com uma média de 12,8. Recomenda-se que os aplicativos disponíveis sejam revisados e que futuros aplicativos sejam desenvolvidos utilizando práticas baseadas em evidência para a cessação do tabagismo.

Given vulnerability to COVID-19 among smokers and vaccine hesitancy among populations disproportionately burdened with COVID-19, it’s important to understand concerns about vaccines and the impact of COVID-19 on these subgroups. Among our all African American (AA) sample of smokers (N = 172) enrolled in a larger smoking cessation clinical trial, results demonstrated an intensive burden from COVID-19; 42 (24.4%) lost employment, 56 (32.6%) lost household income, and 66 (38.4%) reported inability to pay bills and buy food due to COVID. Most, 103 (64.4%), were willing to get vaccinated. Among the vaccine-hesitant, 57 (35.6%), concerns about COVID-19 vaccine development and mistrust in vaccines were primary reasons for unwillingness to get vaccinated. Few identified doctor’s advice as most valued in deciding if the vaccine was the best option. Findings highlight high openness to the vaccine among smokers impacted by COVID but reiterate the need for community-engaged versus health system-driven approaches to improve vaccine hesitancy among racial/ethnic minorities.

Gain- and loss-framed messages about smoking behavior have commonly been used to promote cessation. However, there are still no clear conclusions as to what kind of message is more effective for motivating smokers to quit. This study compared the effectiveness of loss- and gain-framed messages in the online recruitment of smokers via Facebook Advertising. Loss- and gain-framed messages about smoking were created and released as Facebook ads. Users who clicked on the ads were automatically redirected to the “Live Without Tobacco” intervention (http://www.vivasemtabaco.com.br). The amount spent on the ads was BRL 647.64. Data were collected from the Facebook Ads platform and from a relational database. Analyses were performed on the 6,350 users who clicked on one of the ads and 1,731 who were successfully redirected to the intervention. Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527. The former received 2,688 clicks, while the latter received 3,662. The cost of the click was BRL 0.12 per gain-framed ad and BRL 0.09 per loss-framed ad. Loss-framed ads reached more users, got more clicks (and website accesses), and led to more accounts and quit plans being created. Loss-framed messages about smoking appear to be more cost-effective for both initial recruitment and intervention engagement. Facebook has proven to be a good outreach and recruitment tool and can be a solution for the difficulty in reaching smokers for cessation interventions.

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.