Study Reveals Stigma Against Smokers Among Future Healthcare Providers

What if your healthcare provider judged you before even meeting you? This troubling scenario is reflected in a recent study that found healthcare trainees harbor significant biases against patients with a history of smoking, regardless of their cancer diagnosis. Published in June 2024 in the Journal of the National Cancer Institute Monographs, the research highlights how smoking stigma shapes perceptions of patients and raises questions about its potential impact on clinical care.

To conduct this study, a group of researchers, including corresponding author Jamie L. Studts, Ph.D., a professor and oncologist at the University of Colorado Cancer Center, analyzed responses from 94 medical students and 138 nursing students. The researchers used two methods to explore lung cancer stigma among healthcare trainees. First, they created short patient vignettes that varied in two key ways: the patient’s smoking history (smoker or nonsmoker) and cancer type (lung or colorectal).

Second, they added a behavioral test. After reading the vignettes, participants were given money and asked to donate it between two cancer charities—one for lung cancer and one for colorectal cancer. The idea was to see if donation behavior revealed biases that participants might not openly express in survey responses, as donating feels less direct than answering questions about stigma.

The results showed consistent patterns of stigma: trainees were more likely to view patients who smoked with greater anger, more pity and less willingness to help. These effects were found to be statistically significant.

Interestingly, the type of cancer (lung or colorectal) did not reliably influence participants’ perceptions. This finding suggests that stigma may stem more from attitudes toward smoking than from a lung cancer diagnosis itself. Unlike the vignette responses, no significant differences emerged in donation behavior, indicating that implicit biases may not always translate into observable actions.

These findings show that individuals who smoked may still be viewed through a stigmatizing lens, even by future healthcare professionals.

“Unfortunately, the implications are suboptimal, meaning that individuals seeking care for illnesses linked to smoking are more likely to experience stigma and bias that could potentially impact their care,” Studts said in an email interview with MHE.

“It is not appropriate to make patients and caregivers responsible for this burden,” he said. “It is the responsibility of clinicians to treat individuals with respect and without bias.”

Studts said that patients and caregivers might benefit from being aware of this stigma to advocate for compassionate, optimal care for themselves and their loved ones. “I have to repeat, this is not the responsibility of patients and caregivers, but it may be necessary in the current care environment,” he said.

When asked whether lung cancer stigma is changing in the United States, Studts offered a nuanced view. “The data collected by colleagues at Go2 for Lung Cancer suggest that lung cancer stigma may be increasing, but I have a different interpretation. I think that individuals diagnosed with lung cancer are more willing to acknowledge that they have been treated in a stigmatizing manner and call out the bias they have experienced,” he said.

Studts acknowledged that stigma toward individuals with a smoking history is deeply rooted, often stemming from decades of aggressive tobacco control messages dating back to the 1964 Surgeon General’s report.

“Some level of stigma and bias is almost ubiquitous,” he explained, based on these societal messages. However, he views greater awareness and acknowledgment of stigma as “a good step toward changing how we think and feel about individuals with a current or past smoking history.”

The study highlights the need for proactive efforts to tackle smoking stigma in healthcare training programs. Studts called for societal and professional changes to foster empathy and reduce the biases that burden patients with smoking-related illnesses and emphasized that “Stigma helps no one.”

By addressing these issues early in training, healthcare educators can help ensure equitable and compassionate care for all patients, regardless of their smoking history.