Validity and reliability of the Internalized Stigma of Smoking Inventory: An exploration of shame, isolation, and discrimination in smokers with mental health diagnoses.
OBJECTIVE
De-normalization of smoking as a public health strategy may create shame and isolation in vulnerable groups unable to quit. To examine the nature and impact of smoking stigma, we developed the Internalized Stigma of Smoking Inventory (ISSI), tested its validity and reliability, and explored factors that may contribute to smoking stigma.


METHODS
We evaluated the ISSI in a sample of smokers with mental health diagnoses (N = 956), using exploratory and confirmatory factor analysis, and assessed construct validity.


RESULTS
Results reduced the ISSI to eight items with three subscales: smoking self-stigma related to shame, felt stigma related to social isolation, and discrimination experiences. Discrimination was the most commonly endorsed of the three subscales. A multivariate generalized linear model predicted 21-30% of the variance in the smoking stigma subscales. Self-stigma was greatest among those intending to quit; felt stigma was highest among those experiencing stigma in other domains, namely ethnicity and mental illness-based; and smoking-related discrimination was highest among women, Caucasians, and those with more education.


CONCLUSIONS
Smoking stigma may compound stigma experiences in other areas. Aspects of smoking stigma in the domains of shame, isolation, and discrimination were related to modeled stigma responses, particularly readiness to quit and cigarette addiction, and were found to be more salient for groups where tobacco use is least prevalent.


CONCLUSIONS
The ISSI measure is useful for quantifying smoking-related stigma in multiple domains.
Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, California.
Cati G
CG
Brown-Johnson
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California.
Janine K
JK
Cataldo
Joint Medical Program, University of California Berkeley, School of Public Health, Berkeley, California.|University of California San Francisco, School of Medicine, San Francisco, California.
Nicholas
N
Orozco
Center for Tobacco Control Research and Education, University of California, San Francisco, California.
Nadra E
NE
Lisha
California Tobacco-Related Disease Research Program, University of California, Office of the President, Oakland, California.
Norval J
NJ
Hickman
Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, California.
Judith J
JJ
Prochaska
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D008960:Models, Psychological; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011287:Prejudice; D011567:Psychiatric Department, Hospital; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012752:Shame; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation; D012934:Social Isolation; D057545:Social Stigma; D055815:Young Adult