Background:
Stigma exists when components of labeling, stereotyping, separation, and discrimination occur together in a power situation. This may apply to smoking, a behavior being increasingly denormalized. However, it is unknown whether School Tobacco Policies (STP) may lead to the stigmatization of adolescent smokers. Our aims are (1) to measure the magnitude of each stigmatization’s components and (2)to assess how STPs influence them.

Methods:
Data on 11,493 adolescents in 43 schools in 7 European countries were used (SILNE R-survey, 2016). Dependent variable was Stuber’s scale to measure stigmatization with four items: most people think less of person who smoke, believe that smoking is for losers, most non-smokers would be reluctant to date someone who smokes and would not hire a smoker to babysit children. Independent variables were: being a weekly smoker, having friends smoking, parental smoking and the score of school tobacco policies (STPs). We performed multilevel regressions which include interactions between weekly smoking and other independent variables.

Results:
The most frequent stigmatization components were related to discrimination such as “not to hire a smoker as a babysitter” (77%) and not “dating a smoker” (55%). Smokers always reported less stigmatization compared to non-smokers. Differences between smokers and non-smokers were more pronounced for “not to hire a smoker as a babysitter (62% versus 80%, Chi²= 182, p<0,001) and less so for stereotype: “most people think less of person who smokes” (Smokers: 45%; non-smokers: 52%, chi²= 15, p<0,001). Multilevel regression showed that stigmatization was lower in smokers, increased with none of my friends being smokers, decreased with parental smoking. In addition, smokers felt more stigmatized in schools with higher STPs score.

Conclusion:
Smoking is associated with a loss of status. STPs increase stigmatization within school while social environment (friends and family) decrease stigmatization. This suggest that social ties may reduce the effect of stigmatization on smoking behavior among adolescents.