Exploring Smoking Stigma, Alternative Tobacco Product Use, & Quit Attempts

Perceptions of Smoking Stigma Among African Americans: A Qualitative Study

INTRODUCTION

African Americans/Blacks (AAB) are at increased risk for morbidity and mortality from smoking-related diseases including lung cancer (LC). Smoking stigma is believed to be a primary barrier to health care-seeking for people who smoke. Previous studies illustrate that perceptions of smoking vary across populations. However, little is known about the prevalence of smoking stigmas among AAB. The purpose of this study was to increase understanding of the perception of cigarette smoking by AAB.

AIMS AND METHODS

We conducted free-listing interviews in which individuals listed all-thoughts and feelings regarding smoking and health-related questions with a convenience sample of eligible AAB adults (n = 58) in the Philadelphia region. Additionally, we collected participant self-reported demographic data. Data were cleaned and the salience of each term was computed using Anthropac. Graphical methods were then used to determine salient responses across groups stratified by gender, age, education, and smoking status.

RESULTS

The sample had a median age of 51 years and was 67.2% female. Most participants had completed college (58.6%) and had never smoked (74.1%). Regarding their perceptions of people who smoke cigarettes, results showed that "smelly," "health hazard," and "judgment" were the most salient terms among all-participants. Overall, "smelly" and "unhealthy" were salient for both males and females. However, "dental," "dirty," "addictive," and "habit" were also salient among males. Phrases such as "unhealthy" and "addictive" were primarily salient for older participants (>51 years) versus "smelly" for younger participants. The term "smelly" was salient among all-education levels. However, "unhealthy" was also salient among those with less than a 4-year college degree. Moreover, the terms "smelly" and "annoying" were most common among people who smoke as opposed to "health hazard" among people who don't smoke.

CONCLUSIONS

We observed that the most stigmatizing language was primarily associated with perceptions of negative social interactions, social judgment, and health-related concerns. Future studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and LC screening protocols.

IMPLICATIONS

Little is known about the prevalence of smoking stigmas among AAB. This study explores the AAB perspective of cigarette smoking and related stigmas. Among AAB, smoking is represented by stigmatizing language across gender, age groups, and smoking history. It is primarily associated with negative social interactions, social judgement, and health-related concerns indicating that smoking stigma is a concern for AAB individuals who smoke. Further research is warranted.

Is the perceived public stigma of smokers associated with value opposites? An exploratory cross-sectional analysis of Norwegian data 2011-2013

Smoker stigma is a likely unintended consequence of tobacco polices aiming to denormalise smoking. Little is known about the dissemination of stigmatising attitudes toward smokers at the population level, including their associations with personal values. Applying a theoretical approach that conceptualises stigma as a cultural (moral and intersubjective) issue, we analyse the spread of perceived public stigma of smokers in Norway and factors predicting agreement with such a perception. Using merged data from the biennial national survey Norwegian Monitor 2011 and 2013 (N = 7,792), we tested whether the tendency to agree with a perceived public stigma of smokers differs by four indexes of value opposites ('puritanism/emancipation,' 'conformity/individuality,' 'tolerance/intolerance,' 'status/anti-status'), controlling for smoking status, SES, and demographics. Descriptive statistics and block-wise logistic regression models were applied. In the total sample, 59.1% agree with the statement that 'most people think less of a person who smokes.' Two of the four indexes of value opposites tested were associated with tendencies to agree with the perceived public stigma of smokers ('puritanism/emancipation' and 'status/anti-status'). Smokers with current plans to quit expressed the highest perceived public stigma, while ex-smokers expressed a higher perceived public stigma than never-smokers. Women, young people and respondents with high SES agree with a public stigma of smokers more than men, older people and respondents with low SES do. The perceived public stigma of smokers is high in Norway and varies to some extent with personal values, but also with socio-demographics and especially smoking status.

Carcinogenic and tobacco smoke-derived particulate matter biomarker uptake and associated healthcare patterns among children

BACKGROUND

The objective was to assess the associations of child tobacco smoke exposure (TSE) biomarkers (urinary cotinine, NNAL, and nicotelline N-oxides) and parent-reported smoking and child TSE patterns with total hospital visits, pediatric emergency department (PED) visits, urgent care (UC), revisits, and hospital admissions among 0-9-year-olds.

METHODS

A convenience sample of PED/UC patients (N = 242) who presented to a large, US children's hospital who had baseline urine samples assayed for the TSE biomarkers of interest were included. Biomarker levels were log-transformed, and linear and Poisson regression models were built.

RESULTS

The geometric means of child cotinine, creatinine-adjusted NNAL, and N-oxide levels were 11.2 ng/ml, 30.9 pg/mg creatinine, and 24.1 pg/ml, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.2 (6.1) cigarettes. Each one-unit increase in log-NNAL levels was associated with an increase in total UC visits (aRR = 1.68, 95% CI = 1.18-2.39) among 0-9-year-olds, while controlling for the covariates. Each one-unit increase in child log-NNAL/cotinine ratio (×103) values was associated with an increase in total hospital visits (aRR = 1.39, 95% CI = 1.10-1.75) and UC visits (aRR = 1.56, 95% CI = 1.14-2.13) over 6 months.

CONCLUSION

Systematic screening for child TSE should be conducted during all hospital visits. The comprehensive assessment of TSE biomarkers should be considered to objectively measure young children's exposure.

IMPACT

Higher levels of cotinine, a widely used tobacco smoke exposure biomarker, have been associated with higher healthcare utilization patterns among children. Less is known on the associations of carcinogenic and tobacco smoke-derived particulate matter biomarker uptake with child healthcare utilization patterns. This study assessed the associations of several biomarkers with healthcare utilization patterns among pediatric emergency department patients ages 0-9 years who lived with tobacco smokers. Higher urinary NNAL biomarker levels, in individual and ratio form with cotinine, increased children's risk for urgent care visits over 6 months. Higher parent-reported cumulative child tobacco smoke exposure increased children's risk for hospital admissions.

Modeling Electronic-Cigarette Users' Risk Information Avoidance

The current study examined e-cigarette users' risk information avoidance (i.e., RIA), which is a significant challenge to e-cigarette risk communication. Applying and extending previous RIA studies and the risk information seeking and processing (RISP) model, this study identified the predictors of e-cigarette users' RIA with a comprehensive model that incorporated new roles for scientific uncertainty and relevant channel beliefs. Responses collected from an online survey were analyzed (N = 593) and support was found for two pathways that explain e-cigarette users' motivation for RIA. One suggests heightened risk perceptions were associated with strong negative affective responses that include fear, anger, sadness, and guilt. These affective responses, in turn, were positively associated with RIA intentions. The second was a direct, positive association between scientific uncertainty and RIA as well as an indirect path mediated by relevant channel beliefs. More specifically, scientific uncertainty was negatively associated with quality perceptions of e-cigarette information making it more likely e-cigarette users would avoid it. Suggestions for how to prevent or mitigate these processes that result in e-cigarette users' maladaptive response of RIA are discussed.

The Intersectionality of HIV-Related Stigma and Tobacco Smoking Stigma With Depressive and Anxiety Symptoms Among Women Living With HIV in the United States: A Cross-sectional Study

ABSTRACT

This study examined the intersectionality of HIV-related stigma, tobacco smoking stigma, and mental health among women living with HIV who were daily smokers. This secondary analysis used baseline data from 2 pilot smoking cessation studies. Participants received either an HIV-tailored or an attention-control intervention focused on smoking cessation as an outcome. There were significant positive relationships between HIV-related stigma and depressive and anxiety symptoms. In contrast, tobacco smoking stigma had no significant relationship with either of the symptoms when HIV-related stigma was controlled. However, there was a significant interaction effect (β = 1.37, p = .02) of tobacco smoking stigma with internalized HIV-related stigma on anxiety symptoms. Tobacco smoking stigma worsened anxiety symptoms for women who had high internalized HIV-related stigma. Health care providers should understand the effect of HIV-related stigma on mental health and address the intersectionality of HIV-related stigma with other socially disapproved behaviors, such as tobacco smoking.

Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress

PURPOSE

Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress.

METHODS

This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups.

RESULTS

Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers.

CONCLUSIONS

Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.

Are smoking cessation behaviours among daily smokers associated with a perceived public stigma of smokers? Cross-sectional analyses of Norwegian data 2011–2013

Introduction

Perceived stigma may be an unintended consequence of tobacco denormalization policies among remaining smokers. Little is known about the role of perceived stigmatization in cessation behaviours.

Aims

To test if perceived public smoker stigma is associated with recent attempts to cease smoking and future cessation plans among adult daily smokers.

Methods

Using merged data from the biennial national survey Norwegian Monitor 2011 and 2013 (N daily smokers = 1,029), we performed multinomial and ordinal regression analyses to study the impact of perceived public stigma (measured as social devaluation and personal devaluation) on recent quit attempts, short-term intention to quit and long-term intention to quit, controlling for confounders. One additional analysis was performed to investigate the relationship between stigma and intention to quit on quit attempts.

Results

A significant association between perceived social devaluation and recent quit attempts was found (OR 1.76). Perceived stigma was not associated with future quit plans. Personal devaluation was not associated with any cessation outcome. The role of perceived social devaluation on quit attempts was mainly found among smokers with intentions to quit.

Conclusion

These findings indicate that stigma measured as social devaluation of smokers is associated with recent quit attempts, but not with future quit plans.

Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas

Background

Tobacco Cessation on Prescription (TCP) is a new intervention that is being evaluated in socioeconomically disadvantaged areas in Swedish primary health care (PHC). Patients’ perceptions of TCP are important to understand as this may have implications for the acceptability and adherence to treatment and explain cessation outcomes. Patients’ general experiences of tobacco cessation are also important to explore to improve cessation support in this setting.

Aim

To explore experiences of tobacco cessation and TCP among patients in Swedish PHC focusing on socioeconomically disadvantaged areas.

Methods

Inductive content analysis of transcripts from eight semi-structured interviews with patients recruited from the intervention group in a randomized controlled trial evaluating the effectiveness of TCP in socioeconomically disadvantaged areas in PHC in Stockholm.

Results

Two themes were identified: needing individualized support to quit, taking differences in patients’ experiences of tobacco use and cessation into account, acknowledging individual factors such as impact of health and wellbeing on tobacco use and differing attitudes towards tobacco and cessation and needing a supportive environment to facilitate tobacco cessation, taking contextual factors like professional support from the health care system, the importance of the social environment and supportive societal structures into account. Regarding TCP, the prescription form was perceived as useful for providers but did not appear to have a direct impact on tobacco cessation from the informants’ perspective. However, individualized counseling from a tobacco cessation specialist, an empathetic approach in the treatment and long-term follow-up was considered important.

Conclusion

A holistic approach may be needed in cessation treatment, combined with interventions outside the health care system, to facilitate tobacco cessation among patients in socioeconomically disadvantaged areas in Swedish PHC. The TCP prescription form may be helpful for PHC providers but counseling and follow-up appear to be the most important components of TCP for patients in this setting.

Smoking-Related Stigma: A Public Health Tool or a Damaging Force?

BACKGROUND

Tobacco control policies and other denormalization strategies may reduce tobacco use by stigmatizing smoking. This raises an important question: Does perceived smoking-related stigma contribute to a smoker's decision to quit? The aim of this study was to evaluate if perceived smoking-related stigma was associated with smoking cessation outcomes among smokers in Mexico and Uruguay.

METHODS

We analyzed prospective data from a panel of adult smokers who participated in the 2008-2012 administrations of the International Tobacco Control Policy Evaluation Surveys in Mexico and Uruguay. We defined two analytic samples of participants: the quit behavior sample (n = 3896 Mexico; n = 1525 Uruguay) and the relapse sample (n = 596 Mexico). Generalized estimating equations were used to evaluate if different aspects of perceived stigma (ie, discomfort, marginalization, and negative stereotype) at baseline were associated with smoking cessation outcomes at follow-up.

RESULTS

We found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico.

CONCLUSIONS

This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force. Future studies should evaluate the influence of internalized stigma on smoking behavior.

IMPLICATIONS

Although perceived smoking-related stigma may prompt smokers to quit smoking, smoking stigma may also serve as a damaging force for some individuals, making quitting more difficult. This study found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico.

Impact of Graphic Warning Messages on Intentions to Use Alternate Tobacco Products

Graphic cigarette warnings increase quit attempts. Perceived message effectiveness and message avoidance are predictive of later quit attempts. We sought to examine whether randomized exposure to warning messages would inadvertently increase intentions to use alternate tobacco products while enhancing attempts to quit cigarettes. An online survey of 1392 adult smokers in the US asked participants to rate six randomly selected tobacco warnings (from a set of 319) on perceived effectiveness and avoidance intentions. These two indicators of message effectiveness were calculated at the message-level and then at the individual campaign-level to facilitate causal inference. After viewing a message campaign of six warning messages, participants indicated their intentions to use alternate tobacco products. Sixty-eight percent of participants reported some intention to use e-cigarettes and intentions to use other alternate tobacco products ranged from 31% to 40%. Campaigns of messages eliciting higher avoidance increased the odds of intending to use hookah (aOR: 4.32), smokeless tobacco (aOR: 4.88), and snus (aOR: 8.06), but not the intention to use electronic cigarettes. These relationships are mediated by intentions to quit smoking (all p <.05). Viewing campaigns with higher campaign-level perceived effectiveness increased the intentions to quit, which in turn increased intentions to try alternate tobacco products. Our findings increase the tobacco control community's understanding of unintended consequences of graphic tobacco warnings.

Occupying multiple stigmatized identities: Smoking and unemployment stigmas among the unemployed

Stigma - which involves stereotyping, discrimination, and status loss - is a central driver of morbidity and mortality. Given the de-normalization of smoking and the status loss of unemployment, unemployed individuals who smoke may occupy multiple stigmatized identities. As such, this study examined aspects and correlates of smoking and unemployment stigmas among unemployed job-seekers who smoke. Adult job-seekers who smoke tobacco (N = 360) were recruited at government-run employment development departments (EDDs) in the San Francisco Bay Area in 2015-2018. Participants completed measures of smoking and unemployment stigma and self-reported their demographic, tobacco use, and physical and mental health characteristics. Smoking and unemployment stigmas were moderately positively correlated, and the sample reported higher unemployment stigma than smoking stigma. A sample majority endorsed at least one element of smoking and unemployment stigmas; most common for both was self-disappointment. Two sets of linear regression analyses using a general-to-specific modeling procedure were run to identify significant correlates of smoking stigma and unemployment stigma. Both stigmas were significantly associated with depressive symptoms and with preparing to quit smoking. Participants in poorer health and those with stable housing endorsed greater smoking stigma, while unemployment stigma was endorsed more among White individuals and those with past-year e-cigarette use. The findings highlight the need to examine multiply occupied stigmas as a social determinant of population health.

Smoking Social Norms Among Young Adults in New York City

More than half of young adult (YA) (ages 18-26) smokers are non-daily smokers. While standard cessation methods are generally successful with adults and daily smokers, there is evidence that they are not as successful among non-daily smokers or young adults. Additionally, YA smokers are also in a transition period to regular smoking, making research on understanding how interpersonal and environmental factors affect this group of smokers critical. Randomized time location sampling was used to create a sample of New York City YA bar patrons between June and November 2013, who completed a self-administered survey (1,916 surveys). Questions were asked about perceived smoking social norms, stigma, behaviors, and demographics. Overall, almost half of the YA reported being current smokers (44.1%); one-third were non-daily smokers (36.7%) and less than ten percent were daily smokers (7.4%). Non-daily smokers compared with daily smokers had greater odds of believing New Yorkers disapproved of smoking [adjusted odds ratio (OR_adj 1.76, 95 % CI 1.10-2.79)], keeping tobacco a secret from certain people (OR_adj 1.84, 1.14-2.96) and feeling guilty when smoking (OR_adj: 2.54; 1.45-4.45). Non-daily smokers had 41% lower odds of reporting how people who are important to you disapproved of smoking than daily smokers (OR_adj: 0.59; 0.38-0.94). Further studies of interpersonal/environmental factors among YA smokers may support modifications to cessation programs that result in more successful YA quit attempts.

The role of self-compassion and shame in persons living with HIV/AIDS

Despite the connection between self-compassion, shame, and HIV/AIDS health outcomes in the literature, little is known about the relationship among these variables. Shame and self-compassion work independently of each other and experiences of shame can impede one's ability to engage in self-compassionate responses, which could prevent future health declines. Although shame has been found to mediate the relationship between self-compassion and a variety of mental health outcomes, it has not been examined in the context of HIV/AIDS. The purpose of the current study was to examine how shame mediates the relationship of self-compassion and adherence to HIV/AIDS medications, as well as how shame mediates the relationship of self-compassion and health-related quality of life (HRQL) in people living with HIV (PLWH). This is the first study to look at trait-based shame in PLWH in a sample of 34 patients at an urban outpatient integrated care facility for PLWH. Self-compassion was not correlated with HIV adherence behaviors or HRQL, and shame did not mediate the relationship between self-compassion and adherence or HRQL. However as expected, less shame was related to and predicted better HRQL in PLWH. Self-compassion' relationship to shame, adherence, and HRQL may be context dependent.

Electronic cigarettes: a task force report from the European Respiratory Society

There is a marked increase in the development and use of electronic nicotine delivery systems or electronic cigarettes (ECIGs). This statement covers electronic cigarettes (ECIGs), defined as "electrical devices that generate an aerosol from a liquid" and thus excludes devices that contain tobacco. Database searches identified published articles that were used to summarise the current knowledge on the epidemiology of ECIG use; their ingredients and accompanied health effects; second-hand exposure; use of ECIGs for smoking cessation; behavioural aspects of ECIGs and social impact; in vitro and animal studies; and user perspectives.ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support ECIGs as an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licenced stop-smoking treatments. So far, there are conflicting data that use of ECIGs results in a renormalisation of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out.

Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use

BACKGROUND

Reducing the social acceptability of smoking is associated with lowered smoking prevalence. However, denormalization strategies can also contribute to the stigmatization that some smokers may feel about their smoking. Smoking stigma may be more acute if smokers are also members of other stigmatized groups, such as racial/ethnic minorities. This study examined correlates of smoking self- and felt-stigma and discrimination, among current smokers.

METHODS

Participants were recruited in the United States via a national commercial consumer panel to complete a cross-sectional, Web-based survey. Participants were 1528 current cigarette smokers aged 14 and older. Measures included the Internalized Stigma of Smoking Inventory (ISSI), Heaviness of Smoking Index, quit intentions, past-year quit attempts, and current use of electronic cigarettes (e-cigarettes).

RESULTS

Self-stigma was significantly associated with higher intent to quit in the next 6 months (odds ratio [OR] = 2.47, P < .01) and in the next 30 days (OR = 4.21, P < .01), relative to no intention to quit, as well as having made 1 or 2 quit attempts in the past year (OR = 1.60, P < .01) or 3 or more quit attempts (OR = 1.74, P < .01) and associated with daily e-cigarette use (OR = 1.73, P < .05). Felt-stigma was positively associated with intent to quit in the next 30 days (OR = 1.54, P < .01), having made 3 or more quit attempts in the past year (OR = 1.35, P < .01), and both daily (OR = 2.05, P < .05) and some-day (OR = 1.30, P < .05) e-cigarette use. Discrimination was associated only with increased odds of daily e-cigarette use (OR = 1.83, P < .05).

CONCLUSIONS

Smokers who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts, report a stronger intention quit smoking in the future, and report use of e-cigarettes, suggesting that feelings of self-and felt-stigmatization are related to greater motivation to stop smoking.

Stigmatic and Sympathetic Attitudes Toward Cancer Patients Who Smoke: A Qualitative Analysis of an Online Discussion Board Forum

INTRODUCTION

A significant minority of patients continue to smoke after a cancer diagnosis. Cancer patients who smoke experience stigma that can negatively impact health outcomes. We explored publicly shared perspectives about cancer patients who continued to smoke post-diagnosis.

METHODS

An online news article, published in January 2012, summarized the findings of smoking prevalence among patients with lung cancer and colorectal cancer enrolled in the Cancer Care Outcomes Research and Surveillance Consortium trial. In response, written comments were posted on the articles' public discussion board. Applying principles of grounded theory, we conducted a document analysis and established a conceptual framework to develop a model by which to explain factors underlying stigmatic and sympathetic attitudes toward cancer survivors who continue to smoke.

RESULTS

Personal experiences with cancer, smoking, and statistical literacy were found to influence beliefs about cancer and smoking, which in turn influenced stigmatic or sympathetic attitudes. More sympathetic attitudes were expressed by individuals who had personal experiences with smoking, believed cancer is multicausal, identified smoking as an addiction, or considered extrinsic factors responsible for smoking. Individuals who did not have personal experiences with cancer or smoking, had low statistical literacy, believed that smoking necessarily and directly causes cancer, and focused on intrinsic responsibilities for smoking tended to express more stigmatic attitudes.

CONCLUSIONS

The current findings raise awareness and provide insight into stigma against cancer survivors who smoke and can help inform strategies for reducing stigma against this vulnerable group.

IMPLICATIONS

This study helps raise awareness of stigma toward cancer patients who smoke and provides insight into the processes that may influence stigmatic as compared to sympathetic attitudes toward these patients. Results suggest that population-based strategies to educate the public regarding the nature of nicotine addiction, difficulty of quitting, and benefits of quitting for cancer patients may be useful for reducing stigma against cancer patients with a smoking history.

The neurobiological and behavioral overlaps of nicotine and food addiction

Both cigarette smoking and obesity are significant public health concerns and are associated with increased risk of early mortality. It is well established that the mesolimbic dopamine pathway is an important component of the reward system within the brain and is implicated in the development of addiction. Indeed, nicotine and highly palatable foods are capable of altering dopamine release within this system, engendering addictive like responses in susceptible individuals. Although additional research is warranted, findings from animal and human literature have elucidated many of neuroadaptions that occur from exposure to nicotine and highly palatable foods, leading to a greater understanding of the underlying mechanisms contributing to these aberrant behaviors. In this review we present the findings taken from preclinical and clinical literature of the known effects of exposure to nicotine and highly palatable foods on the reward related circuitry within the brain. Further, we compare the neurobiological and behavioral overlaps between nicotine, highly palatable foods and obesity. Lastly, we examine the stigma associated with smoking, obesity and food addiction, and the consequences stigma has on the overall health and wellbeing of an individual.