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. 2025 Jun;48(3):442-454.
doi: 10.1007/s10865-025-00556-z. Epub 2025 Feb 22.

Perceived and internalized smoking stigma among pregnant women: association with smoking reduction, reactance to smoking health warnings, and intention to discuss smoking with health professionals

Jean-Charles David  1 , N Rascle  2 , M Auriacombe  3   4 , F Serre  4 , A-L Sutter-Dallay  2   3 , D Loyal  5
Affiliations

Perceived and internalized smoking stigma among pregnant women: association with smoking reduction, reactance to smoking health warnings, and intention to discuss smoking with health professionals

Jean-Charles David et al. J Behav Med. 2025 Jun.

Abstract

Background: Tobacco is an addictive substance associated with numerous serious health effects during pregnancy. Pregnant women who smoke face considerable social disapproval, which could be a barrier to seeking healthcare and ultimately to smoking cessation. This study explored how perceived stigma (i.e., smokers' beliefs about negative judgments of them) and internalized stigma (i.e., internalization of stigmatizing attitudes toward them) may be associated with smoking reduction during pregnancy, reactions to smoking health warnings, and the intention to discuss smoking with health professionals.

Methods: A total of 83 pregnant French women who smoke were recruited from maternity wards and online. Participants filled out self-administered online questionnaires assessing smoking dependance (Cigarette Dependance Scale, CDS-5), perceived and internalized smoking stigma (Pregnant Smoker Stigma Scale - Self Stigma, P3S-SS), depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS), reactance to smoking health warnings (shortened version of the Reactance to Health Warnings Scale), and intention to discuss smoking with health professionals (dedicated questionnaire).

Results: In multiple regression analyses that controlled for depressive symptoms and dependance scores, perceived stigma was associated with more reactance (β = 0.35) and less smoking reduction (β = -0.31), whereas internalized stigma was associated with less reactance (β = - 0.0.28). Finally, reactance was associated with less intention to discuss smoking with healthcare professionals (β = -0.26).

Conclusions: These results suggest that perceived stigma may influence reactance to health warnings and smoking reduction during pregnancy, while also indicating that reactance could reduce the intention to consult healthcare professionals. Public health stakeholders should consider how to address the stigmatization of people who smoke, particularly pregnant women, in health communication strategies.

Keywords: Perceived Stigma; Pregnancy smoking; Reactance; Self stigma; Smoking reduction; Stigma.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study has received IRB approval from the Research Ethics Committee of the Paris Cité University (IRB Number: 0012022-9). Informed consent was obtained from all study participants. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

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