Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Ellen J. Hahn


There is longstanding causal relationship between cigarette smoking and lung cancer. Smoke-free policies and anti-smoking campaigns have been linked to the decline in smoking acceptance and contribute to the unintended consequence of stigmatizing smokers. Lung cancer is viewed as a self-inflicted disease and patients’ feel judged in a manner different from other cancers affecting social interactions between family, friends, and healthcare professionals. Lung cancer stigma contributes to depression, anxiety, poor self-esteem, guilt, shame, blame, threatens a person’s social identity, and limits social support that deeply affects patients and their support persons.

This dissertation contains a review of the literature related to smoking and stigma, an evaluation of the psychometric properties of an investigator-developed instrument, “Lung Cancer Stigma Scale” (LuCaSS) and the main findings from a cross-sectional observational study of 104 lung cancer patients assessing factors associated with lung cancer stigma. The Model of Stigma Induced Identity Threat provides the framework to examine stigma and the relationship between social constraints, self-esteem, and smoking and to test whether social support mediates the relationship between stigma, and depression/anxiety.

The LuCaSS was a reliable and valid instrument measuring lung cancer stigma (alpha = 0.89). The principle components analysis determined three subscales measuring internalized stigma: social rejections/judgment, blame/guilt, and shame. Social constraints, self-esteem, smoking each significantly contributed to the prediction of stigma controlling for SES. Lung cancer patients with greater social constraints and lower self-esteem and who were smokers scored higher on stigma. Social support was a mediator for the relationship between stigma and depression but not for anxiety. The findings are consistent with Stigma Induced Identity Threat Model. A stigmatized identity can lead to stress-related health outcomes such as depression.

A lung cancer diagnosis has numerous negative psychosocial effects on patients. Integrating stigma tools (i.e. LuCaSS) in practice settings may assist with determining potential stigma related distress among lung cancer patients. Emphasizing the need for social support and implementing more advocacy efforts may also help minimize the effects of stigma and depression. Future studies are necessary to further examine the role of social support in minimizing stigma and psychosocial distress.

Digital Object Identifier (DOI)