Lung Cancer Stigma: Does Smoking History Matter?

Abstract

Background: Lung cancer patients commonly report stigma, often attributing it to the well-established association of smoking as the leading preventable cause. Theory and research suggest that patients' smoking history may differentiate patients' experience of lung cancer stigma. However, there is inconsistent evidence whether lung cancer stigma varies by patients' smoking history, owing to limitations in the literature.

Purpose: This study examined differences in lung cancer patients' reported experience of lung cancer stigma by smoking history.

Method: Participants (N = 266, 63.9% female) were men and women with lung cancer who completed a validated, multidimensional questionnaire measuring lung cancer stigma. Multivariable regression models characterized relationships between smoking history (currently, formerly, and never smoked) and lung cancer stigma, controlling for psychological and sociodemographic covariates.

Results: Participants who currently smoked reported significantly higher total, internalized, and perceived lung cancer stigma compared to those who formerly or never smoked (all p < .05). Participants who formerly smoked reported significantly higher total and internalized stigma compared to those who never smoked (p < .001). Participants reported similar levels of constrained disclosure, regardless of smoking history (p = .630).

Conclusions: Total, internalized, and perceived stigma vary meaningfully by lung cancer patients' smoking history. Patients who smoke at diagnosis are at risk for experiencing high levels of stigma and could benefit from psychosocial support. Regardless of smoking history, patients reported similar levels of discomfort in sharing information about their lung cancer diagnosis with others. Future studies should test relationships between health-related stigma and associated health behaviors in other stigmatized groups.

Keywords: Disclosure; Health behavior; Lung cancer; Smoking; Stigma.

Fig. 1.

Adjusted mean scores of lung cancer stigma. Total stigma (A), internalized stigma (B), perceived stigma (C), and constrained disclosure (D) by smoking history group. Results are adjusted for age, sex, education, marital status, race/ethnicity, and depressive symptoms. Error bars reflect 95% confidence intervals. LCSI = Lung Cancer Stigma Inventory. *p < .05; **p < .01; ***p < .001.