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Introduction
Tobacco use in high-income countries changed radically over the twentieth century. In the early decades of the century, the production and promotion of manufactured cigarettes drove up smoking prevalence. By the 1940s and 1950s, cigarette smoking (hereafter referred to as 'smoking') had become 'an acceptable and noncontroversial part of US life' (Troyer and Markle, 1983: 124) as it had in the Netherlands and the UK (Forey et al., 2002). Recent decades have seen smoking rates fall, a downward trend more pronounced in higher socioeconomic groups (CDC, 2010; Helasoja et al., 2006; Huisman et al., 2005). In the US and England, the lowest income groups have smoking rates over twice those in the highest income groups: 25 per cent compared with 10 per cent in the US and 37 per cent compared with 15 per cent in England (Craig et al., 2009; Pleis and Lethbridge-Çejku, 2007).
Tobacco control policies are attributed a major role in the overall decline in smoking, through information campaigns and smoking restrictions that convey its social unacceptability. While seen as essential to protect public health, there is a growing appreciation among health researchers that such policies may have contributed to a social climate in which smoking and smokers are stigmatised. The paper reviews and critiques this debate. It focuses on OECD high-income countries and, in particular, on the UK and the US where much of the research on stigma and smoking is located.
The paper begins by noting the changing public attitudes to smoking and the role attributed to tobacco control policies in this cultural shift. It then describes the emerging focus on stigma among public health and tobacco control researchers (hereafter referred to as the public health research community) and the restricted way in which the debate has been framed to date. The subsequent section argues for a broader perspective on the stigmatisation of smoking, situating the process in the context of the widening socioeconomic differentials in smoking and the broader reconfigurations of social class in high-income countries.
Changing social attitudes to smoking
The downward trend in smoking in high-income countries has been associated with increasingly negative perceptions of smoking, both with respect to its health effects and its social acceptability.
Firstly, an increasing proportion of...