title: The downside of tobacco control? Smoking and self-stigma: A systematic review.
abstract: OBJECTIVE
  Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves.
  
  
  METHODS
  We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan's progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles.
  
  
  RESULTS
  Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma.
  
  
  CONCLUSIONS
  While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.
authors.affiliation: The Methodology Center and Prevention Research Center, Pennsylvania State University, University Park, PA, USA. Electronic address: revanspolce@psu.edu.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Evans-Polce
authors.affiliation: Department of Psychiatry, Medical School, University of Sao Paulo, São Paulo, SP, Brazil; Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil.
authors.forename: Joao M
authors.initials: JM
authors.lastname: Castaldelli-Maia
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany; Helios Hanseklinikum Stralsund, Stralsund, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Schomerus
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Evans-Lacko
mesh_terms: D006291:Health Policy; D006801:Humans; D008960:Models, Psychological; D012907:Smoking / Q000331:legislation & jurisprudence / Q000523:psychology*; D057545:Social Stigma; D013240:Stereotyping
keywords: Self-stigma; Smoking; Stigma; Tobacco use