The praise being lavished on CVS in response to its promise to stop selling cigarettes is as profuse as it is predictable. When the drugstore announced last week that it plans to pull tobacco products as it continues to expand into the health care market, doctors, journalists and even the president applauded. “We came to the decision that cigarettes and providing health care just don’t go together in the same setting,” said CEO Larry J. Merlo. "I congratulate–and thank–the CEO of CVS Caremark, Larry Merlo, the board of directors, and all who helped make a choice that will have a profoundly positive impact on the health of our country," said Obama.

CVS’s decision is only the latest in a string of anti-smoking measures that have gone into effect with almost no pushback. In November, Michael Bloomberg’s bill banning the sale of cigarettes to New Yorkers under the age of 21 was met with near-universal support—even though his campaigns against soda and trans fats became fodder for national debates about individual rights and personal freedom. In December, the traditionally smoker-friendly EU voted to implement stricter anti-smoking regulations, including a total ban on the sale of flavored cigarettes.

The lack of resistance to these policies is a reflection of greater awareness of the health risks of smoking, but it’s also a sign of the stigma that’s come to surround cigarettes and the people who still buy them. Tobacco control policies have played a big role in slashing smoking rates—which have fallen from 56 percent of American adults in 1965 to 18 percent today—but they’ve also stigmatized smokers, forcing them to huddle outside public buildings, bars, and now parks. Stigma can be useful if it deters people from smoking, but it can have nasty side effects—like tempting smokers to hide their habits from their doctors, placing an added burden on already vulnerable populations, and making diagnoses of smoking-related diseases embarrassing (on top of life-threatening). Health care officials know this: that’s why they’ve fought to lessen the stigma attached to other conditions and behaviors, from AIDS to depression. “Stigmatization represented a profound psychological and social burden on those with AIDS or HIV infection and it also fuelled the spread of the epidemic,” wrote Jennifer Stuber and Ronald Bayer in a 2006 paper in the American Journal of Public Health. “Yet, in this instance, the concerns about the impacts of stigmatization have been given little consideration.”

Thanks to anti-smoking crusaders, “The fragrant has become foul,” wrote medical historian Allan Brandt in 1988. “An emblem of attraction has become repulsive; a mark of sociability has become deviant; a public behavior now is virtually private.” More recently, psychologists have found that smokers are seen as “outcasts” and even “lepers.”

When did it become acceptable to give smokers dirty looks?





For a recent paper in the Journal of Social Policy, Professor Hilary Graham of the UK’s York University charted the changing focus of anti-smoking campaigns.