Article

Journal of Marketing Research

2021, Vol. 58(2) 223-245
Marketing, Through the Eyes ª American Marketing Association 2021
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DOI: 10.1177/0022243720975400
journals.sagepub.com/home/mrj

Colleen M. Harmeling, Martin Mende, Maura L. Scott,

and Robert W. Palmatier

Abstract
A consumer’s personal attribute (e.g., disease, body weight) can assume the qualities of a stigma (i.e., become a source of
devaluation by others) in the presence of certain audiences, which can affect consumption and represent a major hurdle to
marketers in many industries (e.g., health care). Two field experiments manipulating the marketing communications sent to 1,453
consumers diagnosed with 87 diseases of varying stigma potential, as well as two Amazon Mechanical Turk studies, reveal that
consumers with potentially stigmatizing attributes distinctly decode aspects of marketing communications as audience cues, to
infer how (un)favorable observers of their consumption will be in light of the potential stigma. When consumers possess
potentially stigmatizing attributes, audience cues influence social devaluation inferences, which influence their beneficial con-
sumption (program enrollment, long-term engagement in health care program; e.g., 64% click-through decrease) and their
interest in detrimental consumption (products that promise to alleviate the stigma but are associated with considerable risks).
Anticipated empowerment may increase beneficial consumption among consumers managing stigmatizing attributes.

Keywords
Consumer stigma, field experiments, social devaluation, consumer empowerment
Online supplement: https://doi.org/10.1177/0022243720975400

A stigma occurs when others judge an attribute of a person as
negatively deviating from what they consider normal and devalue
the person because of this attribute (Goffman 1963). Personal
attributes such as health conditions (e.g., HIV, obesity) or finan-
cial status (e.g., poverty) can manifest as stigmas (Goffman
1963). Even new diseases (e.g., COVID-19) can quickly become
stigmatizing (Centers for Disease Control and Prevention 2020).
We propose that marketers need to understand that consumers
with potential stigmas often feel they are constantly “on stage”
and are unable to be themselves, for fear of being “reduced to the
stigma itself” by unfavorable audiences (Hebl, Tickle, and
Heatherton 2000, p. 289). We theorize that a stigma uniquely
transforms consumers’ judgments of and responses to marketing
communications, by making consumers more vigilant in identify-
ing and reacting to audience cues—facets of the communication
that inform consumers’ inferences about others they may encoun-
ter during consumption (e.g., other consumers) and how these
others might judge them. For example, consumers with stigma-
tizing body weights may perceive seemingly neutral information
such as the aspirational, fit models in typical gym ads as cues of an
unfavorable, potentially threatening audience (e.g., due to social
devaluation), rendering the marketing communication ineffective
or even detrimental. The same cue may be a positive signal to
consumers with nonstigmatizing body weights.1 This research
examines how and when stigma shapes consumer responses to
marketing communication, including responses that likely bolster
their well-being (e.g., join a health program), and those that
undermine it (e.g., pursue offerings that promise to reduce the
stigmatizing attribute quickly at considerable risk, such as baria-
tric surgery for weight loss).
Subtle and often ignored aspects of marketing communica-
tions can inadvertently serve as audience cues. Because stigma
1
Other examples include HIV-related public health campaigns that often
deliberately leverage negative deviations (e.g., fear, shame, disgust appeals);
notably, such campaigns often fail (Fairchild, Bayer, and Colgrove 2015).
Colleen M. Harmeling is a Persis E. Rockwood Associate Professor of Marketing,
Florida State University (email: charmeling@business.fsu.edu). Martin Mende is
Professor of Marketing and Jim Moran Professor of Business Administration,
Florida State University (email: mmende@business.fsu.edu). Maura L. Scott is a
Persis E. Rockwood Professor of Marketing, Florida State University (email:
maura.scott@fsu.edu). Robert W. Palmatier is John C. Narver Chair of
Business Administration, Professor of Marketing, Foster School of Business,
University of Washington (email: palmatrw@uw.edu).
224
can dramatically affect consumers’ presentation of self in front
of others (Goffman 1963), we focus on three aspects of ads that
enable self-to-other comparisons: a demographic description of
co-consumers, visual imagery, and an identified source of the
communication. We use these aspects to determine the breadth
of cues that trigger consumers to anticipate an unfavorable
(socially devaluing) versus favorable (benevolent) audience,
and how this affects their consumption.
We examine our conceptual model with four experiments in
health care settings (potential stigma: disease and body
weight). In these contexts, we observe personal attributes with
low or no stigma (e.g., anemia, normal body weight) relative to
high stigma (e.g., HIV, obesity) and manipulate audience cues
in marketing communications. Study 1 is a longitudinal field
experiment, conducted in collaboration with a health care firm,
that includes 483 consumers diagnosed with 87 diseases and
tests the effect of stigma on consumers’ immediate (click-
through) and enduring (e.g., consumer posts, likes over time)
responses to audience cues in marketing communications.
Study 2’s experiment, conducted using Amazon Mechanical
Turk (MTurk), then examines consumers’ anticipated social
devaluation as an underlying mechanism mediating the effect
of stigmatizing attributes on consumption. Studies 3 and 4
validate consumers’ inferences about a potential audience’s
intentions toward them (anticipated devaluing or benevolent
audience intentions) as key processes through which marketing
communications differentially affect consumer responses
among those with potentially stigmatizing versus nonstigmatiz-
ing attributes.
Our work offers multiple contributions to the marketing
literature. First, we show that a personal attribute can take on
the qualities of a stigma (i.e., consumers fear it as a source of
devaluation) and affect consumption in relation to specific
anticipated audiences. Integrating across our studies, we find
evidence that consumers estimate threats related to a poten-
tially stigmatizing attribute along a continuum that ranges from
minimal threat (anticipated benevolent audience intentions) to
high threat (anticipated devaluing intentions) depending on the
degree to which consumers can accurately assess whether the
stigmatizing attribute is shared or unshared with the audience,
which signals a favorable or unfavorable power differential
between the consumer and the audience. Thus, when managing
potential stigmas, consumers’ threat assessments vary across
audience attribute cues, from no information about the audi-
ence relative to the stigma, to a shared cue (e.g., HIV patient
with an audience of other HIV patients), to an ambiguous cue
(e.g., Type 2 diabetes customer with an audience of people
suffering from various diseases), to a contrasting cue (e.g.,
obese consumer with an audience of thin people). Both ambig-
uous and contrasting cues allow inferences that the potentially
stigmatizing attribute is not shared with the audience; we
describe these as “unshared cues.” This continuum (from no
information, to shared cues, to unshared ambiguous cues, to
unshared contrasting cues) is crucial because it reveals insights
into how consumers managing stigmatizing attributes screen
for and respond to threats. To prevent unwanted effects and
Journal of Marketing Research 58(2)
effectively target consumers with potential stigmas, marketers
must understand where communications fall along this conti-
nuum (e.g., in Study 4, failing to refine communications in light
of a stigma reduced click-through rates for a beneficial offering
by 41%).
Second, we find that certain audience cues can inadvertently
hinder beneficial and encourage detrimental consumption out-
comes, illustrating the dangers of stigma in consumers’ deci-
sion making and their future well-being. For example, in Study
1, across 87 diseases ranging in their level of stigma, ambig-
uous audience cues reduced consumers’ participation in bene-
ficial health programs relative to shared audience attribute
cues. Moreover, among consumers managing a potential
weight stigma, Study 2 demonstrates that the commonly used
marketing tactic of aspirational images (e.g., thin models in ads
for fitness centers) can signal an unfavorable audience (con-
trasting along the stigmatizing attribute of body weight); more-
over, these aspirational images increase overweight
consumers’ interest in offerings that promise to alleviate the
stigma quickly (e.g., weight loss surgery) but that often come
with high physical risks (e.g., malnourishment, even death) and
financial costs. Thus, our research can help organizations and
policy makers design more effective communications that pre-
vent (unintentionally) nudging consumers who are managing
stigmas away from beneficial and toward harmful consumption
(e.g., Chaney, Sanchez, and Maimon 2019).
Third, we find that consumers prioritize the stigmatizing
attribute in their definition of self, such that other typically
more dominant indicators of similarity (e.g., gender, race) are
subordinate to it (Study 2), thereby providing deeper insights
into how people prioritize multiple dimensions of homophily
(e.g., Block and Grund 2014; Lin and Lundquist 2013). Further,
we find that consumers managing potential stigmas may oper-
ate with the assumption that all “others,” even those that might
even be similar to them, may be a threat unless there are cues
that the stigmatizing attribute can be concealed (Study 3) or
cues that directly signal the audience’s benevolent intentions
(Study 4). These findings identify theoretical insights and man-
agerially relevant factors when similarity does not produce
expected homophily effects.
Fourth, we discover (Study 3) that consumers managing a
stigma make not only inferences about anticipated audiences,
but also stigma-relevant assessments of (1) the offering and (2)
the marketer. In terms of the offering, we find that, when con-
sumers possess a potential stigma, they respond particularly
favorably to beneficial offerings they perceive as opportunities
for their empowerment in that the offering may help them
overcome the adversities associated with their stigma (Shih
2004). However, in terms of the marketer, Study 3 shows a
detrimental spillover effect: not only do consumers managing
a stigma consider their consumption audience to be unfavor-
able toward them, but they also make detrimental inferences
about the organization that promotes the focal consumption.
Overall, our findings suggest that marketers need to better
understand the relevance of seemingly benign cues in their
marketing communication, which may signal audience
Harmeling et al.
characteristics and intentions to consumers managing stigmas,
thereby reemphasizing the need for paradigms of positive mar-
keting (Mick et al. 2012).
Stigma, Consumers, and Inferred Audiences
A stigma is an attribute of a person that negatively deviates
from what others consider normal in a particular social context;
it can be “deeply discrediting,” to the point that its possessor is
vulnerable to global devaluation by others (Crocker, Major,
and Steele 1998; Goffman 1963). However, by definition, not
all deviant attributes are stigmas, and no attribute in isolation
can be a stigma (Goffman 1963). Rather, stigma implies a
social hierarchy in which the stigma possessor is in last (or a
lower) place; they are assigned to this position by dominant
others (i.e., an audience) in the focal social context. It is this
audience that defines what is “normal,” determines acceptable
tolerance around this standard, and assesses what is deviant and
valued (Lin and McFerran 2016; Wooten 2006). For example,
extreme intelligence can be a source of pride in certain social
circles but, in others, may be “taken as a sign of social
ineptitude” and ridiculed (Wooten 2006, p. 189). Thus, an
attribute’s status as a stigma depends on the audience to which
any person is exposed in a given (consumption) setting.
In consumption settings, stigma can influence the acquisi-
tion, use, and disposal of possessions (Wooten 2006). It can act
as a “psychic boundary” that motivates consumers to hide con-
sumption practices (Kozinets 2001), avoid participation in pro-
motions (Tepper 1994), limit their consideration sets, ignore
being cheated, or refrain from consumption altogether (Adkins
and Ozanne 2005) to avoid stigma-associated risks. To under-
stand the nature of the audience and how consumers sense its
favorability toward them, we review extant marketing research,
primarily ethnographic studies, that investigate consumption
practices that can be sources of stigma (Argo and Main 2008;
Kozinets 2001; Muniz and Schau 2005; Tepper 1994) or con-
sumption as a means to manage stigmas (Adkins and Ozanne
2005; Coskuner-Balli and Thompson 2013; Hill and Stamey
1990; Kates 2002) (see Table 1 for summary).
Stigma and Consumers’ Inferred Audiences: Social,
Economic, and Physical Consequences
Across diverse consumption contexts, prior research hints at
the idea of an implied boundary between people who possess a
stigma and those who do not, with the latter manifesting as an
ever-present, potentially threatening audience for whom the
consumer managing the stigma performs (Kates 2002; Kozi-
nets 2001). The audience can be family or friends, but in the
marketplace, it consists of other consumers and service provi-
ders too (Sandikci and Ger 2009). Importantly, audience reac-
tions can vary widely from benevolent and empowering to
devaluing and threatening (Shih 2004). Consumers search for
those who are sympathetic or empathetic to the stigma often by
finding those who share it. However, the extreme variance in
audience reactions makes stigma management a volatile and
225
dynamic process in which consumers (must) learn to anticipate
conditions in which the potentially stigmatizing attribute will
be problematic (Dovidio, Major, and Crocker 2000).
Revealing a stigmatizing attribute to an audience might be
associated with real or imagined social consequences (e.g.,
“they treat you like you’re nobody”; stigma: homelessness; Hill
and Stamey 1990, p. 312), economic consequences (e.g., “not
entitled to the same services”; stigma: senior citizens; Tepper
1994, p. 505), or physical consequences (e.g., bodily harm by
others in the marketplace; stigma: sexual orientation; Kates
2002). Thus, for consumers managing potential stigmas, others
present at the time of consumption can range from merely
irrelevant bystanders or empathetic co-consumers with bene-
volent intentions to audiences that might challenge their very
existence, question their worth to society and entitlement to
certain economic benefits, or even inflict physical harm.
Underlying each of these varied threats is the notion that
certain audiences may socially devalue the stigma possessor by
reducing the person’s worth from “a whole and usual person to
a tainted, discounted one” (Goffman 1963, p. 4). Once an audi-
ence devalues a consumer based on a personal attribute, it
creates psychological conditions that allow them to exclude
this consumer from basic human protection, “making it permis-
sible to treat [her] in a way that would be morally objectionable
if [she] were fully human” (Goff et al. 2014, p. 527). Thus, fear
of harm tends to outweigh expectations of benevolence and
appears to be warranted, because social devaluation removes
the person from the moral confounds of human rights, in the
eyes of that focal audience.
Stigma and Sensing the (Un)favorability of an Audience:
Audience Cues
Real and imagined threats related to possessing a stigma coin-
cide with evidence that consumers constantly and vigilantly
attempt to protect themselves from the harm an unfavorable
audience may inflict on them (Kates 2002). Because it is
impossible to know with certainty another’s intentions, consu-
mers with potential stigmas learn to sense and interpret subtle
cues and develop context-sensitive judgments to estimate the
nature of an anticipated audience (Kates 2002). As a proxy,
consumers use their stigma to filter visible markers or subtle
behaviors that signal another person shares the focal or similar
stigma (i.e., audience attribute cues) and use these signals to
divide the world into those who are presumably sympathetic or
empathic to the stigma with benevolent intentions toward them
and those who are not (Adkins and Ozanne 2005; Frable, Platt,
and Hoey 1998). Yet, attribute similarity is an imprecise proxy
accompanied with a high risk of inaccurately estimating others’
intentions. Consumers often look for more explicit cues of
benevolent intentions (i.e., audience intention cues), such as
body language (e.g., smile; Hill and Stamey 1990) or overheard
conversations about someone possessing the stigma (Coskuner-
Balli and Thompson 2013), to supplement risky inferences
made by attribute cues alone.
226
Table 1. Stigma and the Ever-Present Audience: Themes and Evidence from Extant Marketing Research.
Theme (Description)
Stigma and consumers’ inferred audiences: social, economic, and physical consequences
Social consequences: consumers make existential inferences “Another dad told how he was often treated as a persona
about audiences’ impressions of them, indicating they felt
insignificant, like they did not exist, or were nothing in the
eyes of certain audiences
Economic consequences: consumers voice economic
concerns, such as ignoring being cheated or not being
entitled to the same economic benefits
Physical consequences: consumers express concern about “So every time I see a black man beaten on TV for no reason,
bodily harm
Illustrative Quote (Stigma Source; Citation)
non grata when taking his children to public parks,
lamenting that ‘moms would talk over me, as if I was not
even there.’ The at-home fathers in attendance bonded
over stories about the myriad disapproving and
judgmental comments they received from their in-laws”
(at-home fathers; Coskuner-Balli and Thompson 2013, p.
32).
“They [shelter employees] don’t care, they treat you like you
nobody. They feel like this—if you in here, you nobody
cause you don’t want to work” (homelessness; Hill and
Stamey 1990, p. 312).
“I was in the store with her, and she bought two boxes of
cereal for $5.00. And, she gave the guy a $10.00 bill. And
the guy didn’t give her the change back…trying to cheat
her…she wouldn’t wait for her change or nothing” (low
literacy; Adkins and Ozanne 2005, p. 103).
“The stigmatizing nature of financially limited
characterizations (i.e., senior citizen discount users ‘don’t
have extra money’ and ‘have very little funds’) was
reflected in participants’ concerns that others would view
senior citizen discount users as financially dependent,
unable to afford the full price…‘second-class citizens’ who
should not be entitled to the same services” (age; Tepper
1994, p. 505).
the boys have to be taught—[as] my dad used to say—
‘how to handle yourself’…to avoid or minimize negative
interactions with authority” (race; Crockett 2017, p. 565).
There were occasional police reports and continual gossip of
physical and verbal attacks on people presumed to be gay
or lesbian (i.e., gay bashing) in the area (sexual orientation;
Kates 2002).
“One of our informants…became the victim of bum burning-
a sadistic practice of gangs of teenagers who pour gasoline
on a sleeping homeless person and then set him or her on
fire” (homelessness; Hill and Stamey 1990, p. 313).
Explanation
The statement “moms would talk over me, as if I was not
even there” highlights a threat of nothingness or lack of
worth. This example also illustrates that similarity without
gender similarity is not enough to ensure audience
favorability.
The informant identifies shelter employees as critical
audiences and anticipates they will devalue the person to
“nobody” or reduce her or his worth.
The informant describes an instance with her mother who
has low literacy (stigma source) and who was willing to
accept being cheated out of her change rather than risk
exposing the stigmatizing attribute to an unfavorable
audience.
Illustrates the potential economic consequences of exposing
a stigmatizing attribute, in that onlookers may infer, based
on their senior citizen status, that consumers are “not
entitled to the same services.”
Implies the importance of developing skills to identify cues of
an audience’s (in this case authorities’) favorability, with
potentially fatal mistakes if misread.
Illustrates the real physical harm that can be inflicted on a
person because of the stigmatizing attribute.
Provides another illustration of the physical harm others may
inflict on a person bearing a stigma.
(continued)
 Table 1. (continued)

Theme (Description) Illustrative Quote (Stigma Source; Citation) Explanation

Stigma and sensing the un/favorability of an audience: audience cues

Audience attribute cue: pieces of information that allow the “Baxter: ‘Now coming [to a black-owned restaurant], I don’t Uses the restaurant owner’s race as a cue that the audience
consumer to estimate if an observer possesses the same know about you, but I’m just more relaxed.…I don’t of his consumption at a restaurant will be favorable
or similar stigma worry about, if we get loud somebody’s going to say, “get toward him.
out.” Or, “you’re disrupting my business”’” (race;
Crockett 2017, p. 564)
“Participants frequent[ly] remark[ed] that they hesitated to Implies the use of age and financial status as cues that
use senior citizen discounts in the presence of others who consumers with a potentially stigmatizing age might use to
were younger, financially better-off, or both (as indicated infer the favorability of an audience.
by reference to ‘yuppies’) reflected concerns for others’
evaluations of them as ‘old’ and/or ‘financially limited’”
(age; Tepper 1994, p. 508).
“The gaydar framework later becomes quite useful when Stigmatized consumers learn subtle differences in
identifying gay men in ambiguous social consumption performances “between consumers with the
circumstances…gaydar provides a myriad of subtle and stigma and without” that allow them to identify others
personalized ways of ascertaining the boundaries of the with the stigma in “ambiguous social circumstances” even
subculture.…informants searched for and read when the stigmatizing attribute is concealed or reluctantly
cues.…informants developed holistic, highly context- disclosed.
sensitive judgment…that encompasses not only dress but
also the subtleties in the ways that clothes are displayed”
(sexual orientation; Kates 2002, p. 389).
Audience intention cue: pieces of information that allow the “One young wiper avoids trouble by reading facial Illustrates that consumers managing a stigmatizing attribute
consumer to determine observers’ general benevolence expressions to determine whether to approach a car. often use body language of others to infer their intentions.
or specific acceptance of the stigma You’ve got to really look at ‘em.…If they smile, you shine
their window [BM, thirties]” (homelessness; Hill and
Stamey 1990, p. 311).
“I’ll be out with 2 of my friends and they work, they are full As part of the audience of another person bearing a similar
time workers, engineers in fact, and they might make a stigma, the informant interprets comments about the
belittling comment about a stay home mom you know, I’ll stigmatizing attribute as an indicator of others’ favorability
be standing there wait a second, I am a stay home dad toward him.
what do they think of me?” (at-home father; Coskuner-
Balli and Thompson 2013, p. 28).

227
228 Journal of Marketing Research 58(2)

Marketing
Communication Characteristics

Audience cues
S1, S2, S3, S4

Consumer Inferences Consumption Outcomes

Consumer anticipated
Beneficial consumption
devaluing (vs. benevolent)
behaviors
audience intentions
Consumer’s + S1, S3, S4
S2, S3 +/−
potential stigma
S1, S2, S3, S4
Consumer Detrimental consumption
anticipated empowerment behaviors
S3 S2, S3

Figure 1. Effects of stigma on consumer responses to marketing communications.

Notes: S1 ¼ Study 1, a 2 (audience attribute cue)  measured (disease-related stigma) longitudinal field experiment on 483 patients across 87 diseases. S2 ¼ Study
2, a 3 (audience attribute cue)  measured (stigma source: body mass index) experiment. S3 ¼ Study 3, a 2 (body weight exposure cue)  measured (stigma
source: body mass index) experiment. S4 ¼ Study 4, a 2 (audience attribute cue)  2 (audience intention cue)  measured (disease-related stigma) field
experiment on 970 patients across 87 diseases.

In summary, stigmatized consumers use cues in their envi-
ronment such as visible similarities, behavioral subtleties, and
observations as an audience member themselves, to sense the
(often hidden) intentions of potential audiences, which can
range along a continuum from benevolent to devaluing. Indi-
cators of safe versus threatening audiences provide an impor-
tant frame of reference for consumers’ stigma management and
related consumption decisions.
Stigma and Consumer Responses to
Audience Cues in Marketing Communication
Extant research generally examines the methods consumers use
to infer others’ favorability toward a stigmatizing attribute in
their immediate interactions with them (Crockett 2017; Kates
2002). Yet, consumers often need to use marketing communi-
cations to predict how future consumption encounters might
unfold, on the basis of limited available information and cues
in the communication, along with their memory of prior social
encounters (Hoch and Deighton 1989). This is crucial for mar-
keters to note, as these predictions typically emerge before the
consumer has any social interactions with the focal company;
thus, these predictions might inherently deter consumers from
engaging with the company in the first place.
For consumers with potential stigmas, the consumption fea-
tured in marketing communication can be seen as an unknown,
threatening social encounter (Adkins and Ozanne 2005). Their
history and knowledge of the consequences of inaccurately
reading a situation (e.g., experiencing social devaluation) can
motivate them to go beyond merely considering whether an
offering fits their economic needs, as is typical (Hoch and Ha
1986), and also consider their consumption audience and how
they can ensure self-preservation in front of this audience. We
propose that consumers managing stigmas use audience cues
(e.g., visual stimuli) in marketing communication to infer
where along the continuum of intentions (from benevolent to
devaluing) a potential audience might fall, with implications
for their consumption (see Figure 1).
If audience cues are unshared (i.e., either ambiguous with
regard to the focal attribute, or contrasting relative to the con-
sumer on the focal attribute), the apprehension that coincides
with managing the stigma in unknown social encounters may
cause the consumer to anticipate more negative audience-
related effects (e.g., increased risk of social devaluation)
(Crocker and Major 1989). In general, ambiguous cues allow
inferences that range from very positive to very negative (Nor-
ton, Lamberton, and Naylor 2013). However, for consumers
managing stigmas, communications for offerings that might
improve their well-being (e.g., wellness programs) that include
ambiguous audience cues may allow negative inferences to
dominate, making them less responsive. Similarly, for consu-
mers managing stigmas, unshared cues that are contrasting
might elevate interest in high return–risk offerings that they
otherwise might consider unnecessary or undesirable (Schou-
ten 1991) (e.g., weight-loss surgery). In these conditions where
social devaluation threats are high, consumers may adopt
“nothing to lose” mindsets, such that they may believe others
assign little worth to their current self (Brough et al. 2016) and
discount risks of products that might cause physical harm (e.g.,
surgical procedures). If the focal cues signal that the audience
shares the potentially stigmatizing attribute (e.g., health condi-
tions), consumers should derive more favorable inferences
about this audience’s intentions and possible effect on their
well-being (e.g., decreased risk of social devaluation, increased
inferences of benevolent intentions), enabling more beneficial
response to the marketing communication.
Harmeling et al.
In contrast, consumers without the potential stigma typically
do not harbor concerns about social devaluations and thus do
not attend to cues in marketing communication to check for
threats as vigilantly as consumers with the stigma do (Chaney,
Sanchez, and Maimon 2019). Taken together, unshared (i.e.,
ambiguous or contrasting) audience cues may evoke the idea of
unfavorable audiences that elicit greater fear of social devalua-
tion and reduce consumers’ likelihood to engage in beneficial
consumption behaviors but increase their interest in detrimen-
tal consumption. We hypothesize the following effects:
H1a: When consumers with potentially stigmatizing attri-
butes encounter unshared (vs. shared) audience attribute
cues, they have less interest in beneficial consumption
behaviors (e.g., joining/engaging in a wellness program).
These effects are attenuated for consumers with low-
stigma attributes.
H1b: When consumers with potentially stigmatizing attri-
butes encounter unshared (vs. shared) audience attribute
cues or shared audience attribute cues (vs. no cues), they
exhibit greater interest in detrimental consumption beha-
viors (high risk-high return offers). These effects are
attenuated for consumers with low-stigma attributes.
H1c: When consumers with potentially stigmatizing attri-
butes encounter unshared (vs. shared) audience attribute
cues, inferences of socially devaluing (vs. benevolent)
audience intentions affect their interest in beneficial and
detrimental consumption. These effects are attenuated
for consumers with low-stigma attributes.
Although we hypothesize the role of audience inferences
(ranging from benevolent to socially devaluing) in influencing
consumption decisions, we note that there might be characteris-
tics related to the offering in which a seemingly negative attribute
could be transformed into a source of empowerment (Conrad and
Caldwell 2006; Shih 2004). Experiences and knowledge that can
be acquired only through a history of stigma-related devaluation
can create a unique expertise related to successfully navigating
challenging social situations; this expertise might have value in
certain consumption contexts. Providing consumption opportuni-
ties that allow stigmatized consumers to use and share their
unique knowledge with others might help them feel empowered
and motivate more positive responses. We therefore also explore
the role of empowerment (in Study 3).
Empirical Overview and Research Context
We conducted four experiments in a health care context, includ-
ing two field experiments (Studies 1 and 4), with an online health
community provider. Health conditions—the main reason con-
sumers seek health care products and services—are deviations
from what is considered normal, though only some of them (e.g.,
HIV, obesity) are potentially stigmatizing. The marketing of
many health care offerings makes salient the consumer’s health
condition, exacerbating the associated stigma’s effects and dis-
couraging consumption (DiMatteo 2004).
229
In the studies, we use offers of health care products and
services, such as an online health care program, a platform for
consumers to share health-related content about symptoms,
treatments, and outcomes (Frost and Massagli 2008). An invi-
tation to a new online program is an unknown social context,
requiring consumers to estimate the risks and rewards of
responding. Online health care platforms are widely used yet
remain poorly understood (Wang, Zuo, and Zhao 2015; Young
2013). Thus, health care and online health programs offer man-
agerially relevant contexts in which to rigorously test our the-
ory. Table 2 summarizes the four studies.
Study 1: Field Experiment Testing Stigma
and Response to Marketing Communications
Using a longitudinal field experiment and a sample of consumers
diagnosed with a wide variety of diseases (e.g., HIV, cancer,
rheumatoid arthritis; see Web Appendix A), we analyze whether
the degree to which consumers’ diseases are stigmatizing deter-
mines whether they click through on marketing communications
that vary in their audience cues. We also test these effects on
actual consumer engagement behaviors (e.g., likes, comments,
friend requests) over a two-week period following their initial
acquisition. Specifically, we examine the interaction between
audience attribute cues (ambiguous vs. shared attribute cue) and
disease stigma on consumers’ likelihood to join a wellness pro-
gram and longer-term activity within that program.
Study 1: Design, Participants, and Procedures
The study employed a 2 (audience attribute cue: ambiguous,
shared)  measured (disease-related stigma) design. Partici-
pants (N ¼ 483) were consumers who agreed to be contacted
by the collaborating health care firm about their disease and
opened the invitation from the firm. Participants were ran-
domly assigned to conditions, using stratified random sampling
by disease, so each disease was equally likely to appear in each
condition. An email with the company name and logo invited
participants to join either a general health group (ambiguous
audience attribute cue) or a group of others sharing the same
disease (shared audience attribute cue), as follows:
“Thanks for signing up to learn about opportunities to connect with
others about your personal health experiences with (health con-
dition)! You may think your story is ordinary, but to someone who
is struggling with the uncertainty and fear of a health-related issue,
hearing from someone who has been there can make all the differ-
ence. The [ambiguous group / shared disease group] in the [Com-
pany Name] community offers many ways—such as chats, polls,
and blogs—for you to relate and empathize with people about what
you’re going through. As a member living with a chronic condi-
tion, I hope you’ll sign up. By joining [Company Name] commu-
nity and the [ambiguous group / shared disease group], you can
shape the experience and create a community of people who care
about (health condition). Getting started is easy—just click here or
on the button below, sign up to join, and create your profile. I look
forward to welcoming you!”
230
Table 2. Overview of Empirical Studies.
Designs Objectives Sources of Stigma Audience Cues Dependent Variables Findings

Study 1 Longitudinal field experiment;  Illustrate a long-lasting  Disease: actual patients
2 (audience attribute cue: impact of stigma on
shared, ambiguous)  consumer responses to
measured (disease-related marketing communications
stigma) that is dependent on the
audience cues present in
the communication.
 Provide proof of concept
for the importance of
considering stigma by using
real marketing
communications linked to
actual short- and long-term
consumer behaviors.
with various diseases (e.g.,
HIV, cancer, obesity,
Parkinson’s), supplied by a
health care program
provider and rated by two
medical doctors.
Audience attribute cue  Actual consumer click-  When cues about the
(manipulated)
 Shared—described other
members of health care
program as having the
same disease as participant.  Engagement activities
 Ambiguous—no
description of other
members of the health care
program.
through on email potential audience of the
invitation to join an focal consumption are
online health care ambiguous (vs. specified as
program. sharing the same disease as
the consumer), it generates
(likes, comments, posts) 64% fewer click-throughs
two weeks after joining for an online health care
an online health care program among stigmatized
program. consumers.
 Consumers with
stigmatizing diseases who
joined the health program
after receiving a marketing
communication with an
ambiguous (vs. shared)
audience attribute cue
completed 52% fewer
engagement behaviors (e.g.,
likes, posts, comments) in
the two weeks after the
invitation.

Study 2 Experiment; 3 (audience  Illustrate that possessing a  Body weight; measured
attribute cue: shared, potentially stigmatizing
contrasting, control)  attribute motivates
measured (BMI-related consumers to anticipate
stigma) between subjects devaluation by others in a
future consumption
context (social devaluation
as mediating mechanism).
 Demonstrate that when
consumers with body
weights at a stigmatizing
levels infer unfavorable
audience cues, they are
significantly more
interested in an offering
that promises to alleviate
the stigma quickly but
comes with a high risk.
 Provide internal validity to
field study findings (Study
1).
Audience attribute cue  Interest in a high return-  Relative to participants in
body mass index (BMI). (manipulated; McFerran risk product meant to the shared and control
et al. 2009). quickly alleviate the conditions, participants in
 Shared: matched stigmatizing attribute the contrasting condition
participant BMI with photo (i.e., sleeve gastrectomy anticipated more social
of thin (participant BMI < surgery). devaluation from other
30) or heavy (participant consumers, as their BMI
BMI > 30) gym member. approached potentially
 Contrasting: mismatched stigmatizing levels, which
participant BMI with photo led to greater interest in
of thin (participant BMI > high return–risk (e.g.,
30) or heavy (participant bodily harm) products that
BMI < 30) gym member. may help manage the
 Control: no image of other potentially stigmatizing
gym members. attribute (e.g., body
weight).
 Effects persist when
controlling for other forms
of similarity such as gender
and race, specifying the
nature of the cue as an
intention signal rather than
(continued)
 Table 2. (continued)
Designs Objectives Sources of Stigma
Study 3 Experiment; 2 (stigma  Replicate mediation by  Body weight; measured as
exposure: yes, no)  anticipated devaluation.
measured (BMI-related  Test anticipated
stigma) between subjects empowerment as a driver
of stigmatized consumers’
decision making.
 Test the theoretical
underpinnings of the
phenomenon that
consumers with
stigmatizing (relative to
nonstigmatizing) body
weights use cues in
marketing communications
to make inferences about a
potential audience by
manipulating body weight
exposure to the others
present at the time of
consumption, effectively
removing the audience of
the focal attribute or not.
Study 4 Field experiment; 2 (audience  Test of process through  Disease: actual patients
attribute cue: shared, moderation by
contrasting)  2 (audience manipulating consumer
intention cue: benevolent, inferences of audience
neutral)  measured intentions as either
(disease-related stigma) benevolent toward the
stigma or neutral.
 Replicate effects from the
field study (Study 1) and
MTurk studies (Studies 2
and 3).
231
body mass index (BMI).
with various diseases (e.g.,
HIV, cancer, obesity,
Parkinson’s), supplied by a
health care program
provider and rated by two
medical doctors.
Audience Cues Dependent Variables Findings
general liking through
homophily.
Audience attribute cue (held  Likelihood to join an  Consumers with potentially
constant across all online health care stigmatizing body weight
conditions): Described program. are less likely to join a
other members of health  Interest in high return– health care program if cues
care program as “people risk products meant to in the marketing
similar to you.” quickly alleviate the communication suggest
stigmatizing attribute. there is a high risk of
exposing that attribute to
others in the program.
 Effects of stigma on both
beneficial and detrimental
behavior are driven by the
amount of devaluation the
person anticipates and how
empowering the offering is
in light of the stigma.
Audience attribute cue  Actual consumer click-  Among consumers with
(manipulated) through on email stigmatizing diseases, failing
 Shared: source of the invitation to join an to refine communications
communication is a patient online health care in light of a stigma reduced
in the health care program. program. click-through rates for a
 Ambiguous: source of beneficial offering by 41%.
the communication is the
administrator of the health
program.
 Audience intention cue
(manipulated)
 Benevolent: used terms
such as “community of
people that care”
 Neutral: used terms such
as “platform for learning
from others”
232
A: Immediate Effects: Click-Through Rate
Relative to participants who viewed the marketing
communication with an ambiguous audience cue, as
disease-related stigma exceeds the scale midpoint
(JN = 4.08), participants who viewed the shared
40%
audience cue clicked through more.
Click-Through Rate (%)
30%
20%
10%
0%
1 2 3 4 2 3
Disease-Related Stigma Level
Figure 2. Study 1 (longitudinal field experiment): Johnson–Neyman analysis of audience attribute cues by stigma.
Notes: Engagement behaviors include likes, shares, comments, friend requests, and messages over the two weeks following exposure to the experimental stimuli.
Johnson–Neyman points of significance (p < .05) are marked by the shaded areas.
To measure stigma, two medical doctors, blind to the
hypotheses and not otherwise involved in the research, assessed
the 87 diseases represented in the sample and rated the extent to
which each disease was stigmatizing.2 The two dependent vari-
ables are click-through rates and long-term consumer engage-
ment behaviors, measured as the number of behaviors (likes,
friend requests, and comments) undertaken in the two weeks
following entry into the health care program.
Manipulation test. We used a sample of 69 U.S. MTurk partici-
pants (MAge ¼ 35.78 years, 37 women) to test the effectiveness
of our audience attribute cue manipulations. We described the
skin illness psoriasis and asked participants to imagine having it,
then randomly assigned participants to read either the unshared
(ambiguous) or shared email message from the main study.
Next, they indicated the extent to which the audience reflected
the group with a shared illness (“like a generic-health group/like
a specific psoriasis group”; “comprised of people with diseases
other than psoriasis/comprised only of people with psoriasis”;
“not at all similar to me/very similar to me”; “not specific to
psoriasis/very specific to psoriasis”; “distant to me/close to me”;
“not like me/just like me”; “a general health group/a health
group focused on psoriasis”) on seven-point bipolar scales (a
¼ .90). Participants in the shared audience cue condition
2 .86, p ¼ .35). Importantly, these effects are qualified by a
The physicians, one male, one female, came from two top-rated hospital
systems in the northeast and southwest United States. Each responded to the
following items: “Based on the disease or its symptoms, consumers with this
disease often feel that others are uncomfortable with them/treat them as
inferior/prefer to avoid them/can tell that they have this disease/feel it is the
consumer’s own fault for having this disease” (1 ¼ “Not at all,” and 7 ¼ “Very
much so”) and “Overall this disease is stigmatized” (seven-point scale
anchored by “strongly disagree and “strongly agree”; a ¼ .95) (McLaughlin,
Pachana, and Mcfarland 2008). The physicians’ responses were highly
correlated (r ¼ .77, p < .001).
Journal of Marketing Research 58(2)
B: Long-Term Effects: Engagement Behaviors
Relative to participants who viewed the marketing
communication with an ambiguous audience cue, as
disease-related stigma exceeds the JN point (JN =
.40 5.45), participants who viewed the shared audience
cue completed more activities in the two weeks
following their joining the program.
Engagement Behaviors
.30
Average Number of
.20
.10
.00
7 1 2 3 4 5 6 7
Disease-Related Stigma Level
perceived the group as having a shared illness (MShared ¼
5.79, MAmbiguous ¼ 4.81; F(1, 67) ¼ 11.41, p < .001).
Study 1: Results and Discussion
Click-through behavior. We conducted a logistic regression anal-
ysis on click-through behavior as a function of disease-related
stigma, audience attribute cues, and their interaction. The audi-
ence cue main effect is marginally significant (Wald w2 ¼ 2.93,
p ¼ .09), but the stigma main effect is not (Wald w2 ¼ .68, p ¼
.41). More important, these effects are qualified by the pre-
dicted significant two-way interaction (Wald w2 ¼ 10.20, p <
.001; Figure 2, Panel A). In support of H1a, a Johnson–Neyman
(JN) analysis reveals that consumers with highly stigmatizing
diseases are significantly less responsive if the audience cue is
unshared (ambiguously defined) versus shared (possessing the
same disease as the recipient), (stigma level  4.08; z ¼ 1.96, p
< .05). This effect reverses for consumers with low-stigma
diseases (stigma levels  1.83; z ¼ 1.96, p < .05).
Long term engagement behaviors. We conducted an analysis of
variance (ANOVA) on long-term engagement behaviors in the
health care program as a function of the audience attribute cue
factor. The audience cue main effect is significant (F(1, 479) ¼
8.76, p ¼ .003), and the stigma main effect is not (F(1, 479) ¼
significant two-way interaction (F(1, 479) ¼ 6.70, p ¼ .01;
Figure 2, Panel B). Providing further support for H1a, the JN
analysis reveals that consumers with highly stigmatizing dis-
eases engage in fewer activities in response to an unshared
(ambiguous) versus shared (one that signals they share the
same disease) audience cue (stigma level  5.45; z ¼ 1.96, p
< .05). This effect reverses for consumers with low-stigma
diseases (stigma levels  1.74; z ¼ 1.96, p < .05).
Harmeling et al.
In a field study, using unobtrusive measures of stigma and
real, observable consumer behaviors (e.g., joining an online
health program, customer engagement behaviors), Study 1 pro-
vides evidence that audience attribute cues alter consumers’
behaviors when they have a potentially stigmatizing disease.
Specifically, we show that consumers whose diseases are more
stigmatizing are less interested in engaging in beneficial con-
sumption (e.g., online health program) when audience cues are
ambiguous versus specified as sharing a stigmatizing attribute
with other consumers; when stigma is low, this effect is attenu-
ated. An invitation with unshared (vs. shared) audience attribute
cues decreased click-through rates among consumers with
highly stigmatizing diseases (þ1SD) by 64%. Moreover, those
who joined the program after receiving an invitation with an
ambiguous (vs. shared) audience cue completed 52% fewer
engagement activities over two weeks. Importantly, these effects
cannot be explained by homophily, as we would expect only a
main effect of audience cues and no interaction by stigma.
Study 2: Stigma, Audience Cues, and
Anticipated Social Devaluation
We theorize the effects observed in Study 1 are caused by
inferences made by consumers with highly stigmatizing dis-
eases, anticipating that others in the ambiguous (vs. shared
disease) group observing their consumption may devalue them,
due to the disease. However, messages may have audience cues
that contrast the stigmatizing attribute with a nonstigmatizing
one (e.g., using an ad with a thin model when marketing to
obese consumers). In Study 2, we test the mediating role of
anticipated social devaluation and examine contrasting audi-
ence attribute cues using a controlled experiment involving
marketing communications for a full-service health facility
(e.g., fitness, medical weight loss, spa services). Study 1 tested
verbal audience attribute cues. Study 2 tests a visual audience
attribute cue. We use body mass index (BMI) as a potential
source of stigma, because it is associated with a nationally
communicated standard for “normal” and deviant categories
(overweight, obese, and morbidly obese) and is linked to per-
vasive societal stigma (Puhl and Brownell 2006).3 Thus, BMI
provides theory-based levels at which stigma effects are
expected to occur (CDC 2019), as compared with nonstigma-
tizing levels of the same attribute.
Study 1 focuses on a beneficial choice: actual program enroll-
ment behaviors. However, stigma also may influence potentially
3
Overweight and obese people experience stigma (Carr and Friedman 2005;
King et al. 2006), and this stigma becomes more prevalent as they grow
increasingly overweight (Harvey and Hill 2001). To confirm this
assumption, we engaged 61 MTurk participants (38 women, Mage ¼ 34.60
years; MBMI ¼ 27.82) to respond to 11 items regarding weight stigma such
as “In general, people . . . sometimes stigmatize overweight people;
discriminate against overweight people” (seven-point scale anchored by
“strongly disagree and “strongly agree”; a ¼ .93; Meadows and Higgs 2019;
Lewis, Cash, and Bubb-Lewis 1997). Participants expressed beliefs that being
overweight is stigmatizing; the mean is significantly greater than the scale
midpoint (M ¼ 4.90, t(60) ¼ 6.19, p < .001); see Web Appendix B.
233
detrimental purchase decisions. Stigmatized consumers may
seek alternatives that (promise to) offer high rewards—physi-
cally substitute the stigma for a desirable attribute in its place,
but also entail high risk, because it might be irreversible, painful,
or dangerous (Puhl and Brownwell 2006; Schouten 1991).
Therefore, with Study 2 we test whether audience cues in mar-
keting messages influence consumers’ interest in high return–
risk products (e.g., surgical procedures) that promise to quickly
alleviate the stigma by reducing excess weight—but come with
risks of bodily harm (Chang et al. 2014).
Study 2: Design, Participants, and Procedure
We employed a 3 (audience cue: control vs. shared vs.
unshared, contrasting) between subjects  measured (BMI:
stigma source) design. Participants (396 U.S. MTurk partici-
pants; 200 women; MAge ¼ 40.93 years; MBMI ¼ 27.89)4 com-
pleted a two-part study. We use BMI as an indicator of the
degree to which participants’ body weights are stigmatizing
and test anticipated devaluation as a mediator. First, partici-
pants indicated their weight in pounds and height in inches,
which we used to calculate their BMI (703  weight (in
pounds) / [height (in inches)]2). Two days later, participants
were randomly assigned to one of the three audience attribute
cue conditions: a heavy, thin, or no image of a woman (images
adopted from McFerran et al. 2009) who was featured in a
health facility testimonial, as follows:
“Customer Testimonial: I recently joined [Company]. When I first
came to the gym and looked around, the equipment looked great
and the trainers were friendly. Most of the members were in the
same shape that I am in. —Jessica B., [Company] Member”
Participants also read that the facility offered access to
affiliated surgeons focused on medical weight management
and aesthetics. Using the CDC’s label for “overweight” (BMI
> 25), the shared weight condition matched participants with
BMIs greater (less) than 25 to the heavy (thin) consumer
image; the unshared, contrasting weight condition matched
participants with BMIs greater (less) than or equal to 25 to the
thin (heavy) image; the control condition had no image (Nay-
lor, Lamberton, and Norton 2011).
The outcome variable was consumers’ interest in a high
return-risk offering by the health facility (i.e., sleeve gastrect-
omy surgery) (H1b). To better disguise the focal offering and
reduce demand artifacts, we intermingled it among six other
products designed to manage the stigmatizing attribute (BMI)
with a brief description of each, in random order (e.g., weight
loss acupuncture, cool sculpting, body firming detox; see Web
Appendix C for descriptions and stimuli tests). Participants
indicated their purchase interest for each product on five-
4
Participants: 643 completed part 1, and 398 of those completed part 2 (two
days later). Two reported BMIs of < 7 and were removed; the lowest recorded
adult BMI is 7.5. Average BMIs were consistent across time periods (MT1 ¼
26.93; MT2 ¼ 27.89).
234
point scales (1 ¼ “Not interested at all,” and 5 ¼ “Extremely
interested”). We included anticipated social devaluation as a
mediator: “If I met other people at this gym, I think they would
be mortified to meet me; If I met other people at this gym, I
think they would be disappointed to meet me” (seven-point,
“strongly disagree” and “strongly agree”; randomized; a ¼ .67;
Shrauger and Schoeneman 1979). The woman in the images
from McFerran et al. (2009) was of Asian descent, so we con-
trolled for gender and race.5
Study 2: Results and Discussion
Interest in high return–risk product6. An analysis of covariance
(ANCOVA) on interest in the high return-risk product indicates
significant BMI (F(1, 388) ¼ 4.32, p ¼ .04) and audience cue
(F(2, 388) ¼ 4.68, p ¼ .01) main effects. Importantly, the
predicted two-way interaction also is significant (F(2, 388) ¼
6.13, p ¼ .002), see Figure 3A. An omnibus groups regions of
significance (OGRS) analysis locates significant JN regions for
the effect of a multicategorical variable and continuous vari-
able interaction (Hayes and Montoya 2017). The OGRS JN
point is at BMI  29.12 (p ¼ .05), a point within the over-
weight category that is approaching the obese category (see
Figure 3, Panel A). To examine the two-way interaction fur-
ther, we use PROCESS Model 1. Notably, the effect of BMI on
interest in the high return-risk product is only significant in the
unshared, contrasting weight condition (Contrasting: b ¼ .04, t
¼ 3.62, p < .001; Shared: b ¼ .02, t ¼ 1.58, p ¼ .11; Control: b
¼ –.02, t ¼ 1.39, p ¼ .16) supporting H1b. To look at this
another way, we ran spotlight analysis using planned contrasts
(control vs. shared; control vs. contrasting; contrasting vs.
shared). When BMI reaches the CDC designation of obese
(BMI ¼ 30), the shared (F(1, 388) ¼ 3.56, p ¼ .06) and con-
trasting (F(1, 388) ¼ 7.57, p < .01) condition produce greater
interest in the high return–risk product, relative to the control
condition. At higher levels of the obese category (BMI ¼ 37.5),
the contrasting condition produces greater interest in the high
return–risk product than the shared condition ((F(1,388) ¼
2.87, p < .09; see Figure 3).
Anticipated social devaluation. An ANCOVA on anticipated
social devaluation indicates a significant BMI main effect
(F(1, 388) ¼ 18.46, p < .001); the audience cue main effect
is not significant (F(2, 388) ¼ 1.79, p ¼ .17). The two-way
5
Neither the interest in high return-risk products model nor the anticipated
devaluation model showed effects of race (F < 1) and gender (F < 1). When we
removed control variables, the interaction for high-risk return products was
significant (F(2, 390) ¼ 6.28, p ¼ .002), and the interaction for anticipated
devaluation was marginally significant (F(2, 390) ¼ 2.87, p ¼ .058).
6
As a demonstration of robustness, we averaged participants’ interest in all
three surgical procedures, which were all perceived as relatively risky (above
the scale midpoint, but varied in their perceived effectiveness and consumers’
familiarity with the product). The two-way ANOVA for this risky product
interest index reveals main effects of BMI (F(1, 389) ¼ 4.35, p ¼ .04) and
audience cues (F(2, 389) ¼ 4.68, p ¼ .01), and a significant interaction (F(2,
389) ¼ 3.57, p < .01).
Journal of Marketing Research 58(2)
interaction is marginally significant (F(2, 388) ¼ 2.91, p ¼
.06); see Figure 3, Panel B. For this interaction, the OGRS
JN point (p ¼ .05) occurs at BMI  29.36, in the overweight
range. Exploring the interaction, PROCESS Model 1 shows
effects of BMI on anticipated social devaluation in the con-
trasting (b ¼ .07, t ¼ 4.35, p < .001) and shared conditions (b
¼ .02, t ¼ 1.75, p ¼ .08); it is not significant in the control
condition (b ¼ .02, t ¼ 1.32, p ¼ .19). Looked at another way,
when BMI is low (1SD), the conditions are not significantly
different from each other (contrasting vs. control, t ¼ .37, p ¼
.71), (shared vs. control: t ¼ .15, p ¼ .88), (contrasting vs.
shared: t ¼ .22, p ¼ .83). When BMI is high (þ1SD), the
shared and control conditions are not significantly different (t
¼ .04, p ¼ .97); the contrasting condition is significantly
greater than the control (t ¼ 2.54, p ¼ .01) and shared (t ¼
2.84, p ¼ .005) conditions.
Moderated mediation. We examine the mediating role of antici-
pated social devaluation on interest in the high return–risk
product (Process Model 107; Hayes 2015). The independent
variable is BMI, the moderator is audience attribute cues, the
mediator is anticipated social devaluation, and the dependent
variable is interest in the high return–risk product. Supporting
H1c, when the audience cue features a consumer with an
unshared, contrasting body type to the participant, anticipated
social devaluation mediates (a  b ¼ .0105, 95% confidence
interval [CI]: .0041, .0189). It does not mediate when the audi-
ence cue signals a shared BMI (a  b ¼ .0036; 95% CI:
.0007, .0094) or in the control condition (a  b ¼ .0032,
95% CI: .0012, .0119).
The findings in Study 2 suggest that, when consumers’
BMIs are potentially stigmatizing, a popular approach that
firms use to advertise health facilities (i.e., depicting thin,
aspirational models), may increase their interest in risky prod-
ucts that promise to alleviate their stigma (e.g., weight-loss
surgery). In Study 1 we test ambiguous audience cues, which
potentially enable inferences about onlookers that vary from
anticipating others who share or who contrast their stigmatizing
condition (Einhorn and Hogarth 1985); in Study 2 we provide a
contrasting audience cue that should clarify these inferences.
Study 2 also provides evidence that a potential stigma can make
consumers more sensitive to visual as well as verbal (Study 1)
audience cues.
Study 3: Manipulating Exposure of the
Potentially Stigmatizing Attribute to an
Audience
In Study 2, the shared audience attribute cue produced more
interest in detrimental consumption than when the visual audi-
ence attribute cues were removed (i.e., the control condition),
7
We chose Model 10 to accommodate the multinomial nature of our audience
cue conditions, which were dummy coded with the control condition as the
reference category.
Harmeling et al. 235

A: Interest in High Return–Risk Product

2.25 As BMI approaches potentially stigmatizing levels, participants who viewed the
marketing communication with the contrasting audience cue, relative to

Return–Risk Product
participants who were in the control condition (BMI = 30.0) or who viewed the
Interest in High 2.00 shared audience cue (BMI=37.5), were more interested in a high risk (e.g.,
bodily harm) product that may help manage the potentially
stigmatizing attribute (e.g., body weight).
1.75

1.50

1.25

1.00
15 20 25 30 35 40 45 50
Underweight Normal Overweight Obese Morbidly Obese

BMI Level (Potential Stigma Source)

3.25 B: Anticipated Social Devaluation

As BMI approaches potentially stigmatizing levels
Social Devaluation

3.00 (JN = 29.36), participants who viewed the

marketing communication with the contrasting
Anticipated

audience cue anticipated significantly greater risks

2.75 of social devaluation from the potential audience
than those who were in the control condition
or viewed the shared audience cue.
2.50

2.25

15 20 25 30 35 40 45 50
Underweight Normal Overweight Obese Morbidly Obese

BMI Level (Potential Stigma Source)

Spotlight Analysis of Planned Contrasts at Different Levels of BMI for Interest in High Return–Risk Products

BMI (CDC Categorization) Control vs. Shared Control vs. Contrasting Shared vs. Contrasting
15.0 (underweight) F(1, 388)=1.51, p = .22 F(1, 388)= 5.83, p = .02 F(1, 388)=1.60, p = .21
17.5 (underweight) F(1, 388)=1.05, p = .31 F(1, 388)= 4.49, p = .04 F(1, 388)=1.30, p = .25
20.0 (normal) F(1, 388)=0.52, p = .47 F(1, 388)= 2.76, p = .10 F(1, 388)=0.91, p = .34
22.5 (normal) F(1, 388)=0.07, p = .79 F(1, 388)= 0.87, p = .35 F(1, 388)=0.43, p = .51
25.0 (overweight) F(1, 388)=0.16, p = .69 F(1, 388)= 0.04, p = .85 F(1,388)=0.04, p = .84
27.5 (overweight) F(1, 388)=1.44, p = .23 F(1, 388)= 2.51, p = .11 F(1, 388)=0.15, p = .70
30.0 (obese) F(1, 388)=3.56, p = .06 F(1, 388)= 7.57, p < .01 F(1, 388)=0.93, p = .34
32.5 (obese) F(1, 388)=5.16, p = .02 F(1, 388)=11.55, p < .01 F(1, 388)=1.87, p = .17
35.0 (obese) F(1, 388)=5.88, p = .02 F(1, 388)=13.55, p < .01 F(1, 388)=2.51, p = .11
37.5 (obese) F(1, 388)=6.09, p = .01 F(1, 388)=14.36, p < .01 F(1, 388)=2.87, p = .09
40.0 (morbidly obese) F(1, 388)=6.08, p = .01 F(1, 388)=14.63, p < .01 F(1, 388)=3.06, p = .08
42.5 (morbidly obese) F(1, 388)=5.99, p = .02 F(1, 388)=14.65, p < .01 F(1, 388)=3.16, p = .08
45.0 (morbidly obese) F(1, 388)=5.87, p = .02 F(1, 388)=14.58, p < .01 F(1, 388)=3.21, p = .07

Figure 3. Study 2 results: Johnson–Neyman analysis of audience cues by BMI (stigma source).
Notes: BMI ¼ body mass index. Standards for defining stigma levels within BMI come from the Centers for Disease Control and Prevention, https://www.cdc.gov/
obesity/adult/defining.html. OGRS Johnson–Neyman points of significance (p < .05) are marked by the shaded areas.

suggesting any information about the focal attribute (even suggests it is not general visibility to onlookers that affects
information suggesting attribute similarity with audience mem- behavior, but exposure of a consumer’s stigmatizing attribute
bers) may elicit inferences of threats. An audience implies to others. Thus, factors that reduce exposure of this attribute
some degree of public exposure to others. Yet, our theory could render an audience irrelevant and eliminate the effects. In
236
Study 3, we manipulate exposure of the potentially stigmatiz-
ing attribute while holding the audience cue constant to test our
theory. We focus again on online health care offers, a context in
which typically nonconcealable attributes (e.g., body weight)
become concealable. Thus far, we have focused on negative
inferences (social devaluation), but when managing stigmatiz-
ing attributes, consumers may also make positive inferences,
with implications for consumption behaviors. In Studies 3 and
4 we look for evidence of more positive inferences (e.g., antici-
pated empowerment and benevolent intentions, respectively) as
consumption drivers.
Study 3: Design, Participants, and Procedure
In Study 3, again using BMI to capture the level of stigma
associated with participants’ body weight, we test whether
marketing messages that signal body weight exposure will alter
consumers’ responses when their weight is potentially stigma-
tizing, as a means to corroborate the prioritization of stigma-
relevant audience information among these consumers. With a
2 (body weight exposure: yes, no) between  measured (BMI:
stigma source) design, holding audience cues constant, we test
anticipated social devaluation and anticipated empowerment as
mediators. We manipulated body weight exposure as follows
[exposed/not exposed]:
We would like your opinion on a new online health workshop.
Below are the instructions for how individuals sign up for the
program. To Join the Program: The website will use [a full body
photo of you to create an exact silhouette (outline) of your body to
serve as your avatar / an image you select to serve as your graphic
logo]. To protect your identity and anonymity, this is used instead
of showing the actual photo of you. The software will use [your full
body photo to create a silhouette of your body / this line art image],
to represent you when you interact with other members of the
community. To join: Please upload your photo, then enter the
following: [Weight, Height, Age, Gender. /Age, Gender.] The
other people in the community will see your: [Silhouette of your
body based on your photo, Height, Weight, Age, Gender. / Line art
graphic of you, Age, Gender.] [A corresponding graphic with
“Support Group” in the header, also showed a red arrow with either
“Your Photo Here. Upload a photo of you . . . ” or “Get Started.
Create an account . . . ” to begin sharing and receiving support in a
nurturing setting. See graphic in Web Appendix D.]
Manipulation test. As a test of our manipulations, we randomly
assigned 80 paid U.S. MTurk participants (48 women, MAge ¼
35.53 years) to view stimuli from one of the two conditions
(exposed vs. not exposed). Next, they responded to items
designed to measure how exposed they would feel: When inter-
acting with people in this group: “ . . . people could see my
body”; “ . . . people would know my weight; my weight would
be visible and exposed”; “ . . . other people in the group could
see what physical shape I am in”; “ . . . people could judge my
weight” (a ¼ .96). We also examined effort to join: “It would
take a lot of effort / time / energy / work for me to join this
Journal of Marketing Research 58(2)
group” (a ¼ .95): anonymity: “People would not know exactly
who I am”; similarity: “People in this group are likely very
similar to me”; and effectiveness: “Joining this group would
be an effective means of managing my weight” (all seven-point
scales anchored by “strongly disagree and strongly agree”;
random order). The results show that the exposed condition
results in significantly greater feelings of weight exposure
(MExposed ¼ 5.48, MNotExposed ¼ 2.86, F(1, 79) ¼ 62.34, p <
.001). We observed no difference in perceptions of the effort
involved (MExposed ¼ 3.82, MNotExposed ¼3.56, F < 1), effec-
tiveness (MExposed ¼ 4.78, MNotExposed ¼ 5.08, F < 1), or level
of anonymity (MExposed ¼ 4.70, MNotExposed ¼ 4.98, F < 1),
which rules out the possibility that participants perceived one
workshop required more effort to join than the other, one was
more effective than the other, or one was more anonymous than
the other. There was no difference in perceived similarity (MEx-
posed ¼ 4.55, MNotExposed ¼ 4.56, F < 1); thus, we effectively
held the audience constant.
Procedures. Over the course of three days, 389 paid U.S.
MTurk participants (196 women, MAge ¼ 39.16 years; MBMI
¼ 26.47) participated in the experiment.8 First, participants
provided demographics and their body weight and height,
which we used to calculate their BMI. Two days later, the
participants were randomly assigned to assess marketing
communications about a health care program (here, a work-
shop) that focused on benefits to the participants. The audi-
ence cues remained constant across all conditions, indicating
“people similar to you.”
After reviewing the marketing communication, participants
indicated their likelihood to enroll, on the following items: “I
would like to enroll in this program,” “I would like to join this
program,” and “I would like to sign up for emails from this
program” (seven-point scale anchored by “strongly disagree”
and “strongly agree”; a ¼ .96). We further isolated how much
risk participants are willing to assume to quickly alleviate the
stigma by directly measuring their comfort with a given level of
risk for a particular return on products recommended through
the workshop. To this end, we asked the following questions:
“Imagine you could have an Outpatient Medical Procedure
(Daily Medication for Three Months). The procedure (medica-
tion) is designed to get you your ideal body. Please indicate
which option you prefer . . . (0) I would not try this product, (1)
10% chance of success, 5% chance of minor side effects, 1%
chance of serious side effects – (9) 90% chance of success, 45%
chance of minor side effects, 9% chance of serious side effects”
(at each scale point, all percentages were increased by 10%,
5%, and 1%, respectively; a ¼ .84; e.g., Tversky and Kahne-
man 1981). We captured anticipated devaluation using the fol-
lowing items: “Thinking about what it would be like to join this
group, I feel that I will be negatively judged,” “If I joined this
8
Five hundred fifty-two participants completed the first part; we deleted 10
participants because they indicated (impossible) BMIs of < 7, and 389 of them
completed the second part two days later. The average BMIs across both parts
were highly consistent (MT1 ¼ 26.30; MT2 ¼ 26.47).
Harmeling et al.
group, I would feel embarrassed about my weight,” If I joined
this group, I would be humiliated by my weight,” and “If I
joined this group, I would feel distressed about my weight,”
(seven-point scale anchored by “strongly disagree” and
“strongly agree”; a ¼ .91, Blair and Roese 2013). They also
indicated anticipated empowerment: “My experiences with my
weight could be a source of insight for other people in this
group,” “I could really help others in this program by sharing
my personal experiences with my weight,” and “My personal
history with my weight gives me a unique advantage to help
others in this program” (seven-point scale anchored by
“strongly disagree” and “strongly agree”; a ¼ .91, based on
Shih 2004).
Consumption decisions involve a mix of inferences that
include how consumers feel others will judge them, how the
offering may benefit their self-concept, and how they perceive
the marketer’s intentions and their persuasion attempts (Fries-
tad and Wright 1994). We capture the former in our measures
of anticipated devaluation and empowerment, but it may be
that when consumers anticipate devaluation by others, they
may also become more skeptical of the ad. Therefore, we also
capture consumers’ assessments of the manipulative intent of
the ad: “The advertiser tried to manipulate the audience in ways
I don’t like,” and “I was annoyed by this flyer because the
advertiser seemed to be trying to inappropriately control the
consumer audience” (seven-point scale anchored by “strongly
disagree” and “strongly agree”; a ¼ .89, Campbell 1995). We
also included exploratory measures of guilt and shame; see
Web Appendix D for the results and Web Appendix E for list
of variables measured.
Study 3: Results and Discussion
To test both beneficial consumption (joining a wellness
program) and detrimental consumption (interest in high
risk–reward products) while also modeling both proposed
mechanisms (anticipated devaluation, empowerment), we
simultaneously estimated a model in AMOS. This method (1)
accommodates multiple mediators and dependent variables, (2)
enables us to estimate the complex relationships in the model
simultaneously, and (3) is robust to the nonnormality of multi-
plicative terms for testing interactions. As a first step, we con-
ducted confirmatory factor analyses for all multi-item
constructs in our empirical model. The results indicated good
overall fit (w2(38) ¼ 70.49, p ¼ .001; comparative fit index ¼
.99; incremental fit index ¼ .96; Tucker–Lewis index ¼ .99;
root mean square error of approximation ¼ .05; standardized
root mean square residual ¼ .02). All standardized factor load-
ings were .64 or greater and statistically significant at p < .001.
The model exhibited high internal consistency, with average
variances extracted (AVEs) from .70 to .92. The AVE for each
factor was greater than its squared correlation with any other
factor, in support of discriminant validity (see Web Appendix
D for descriptives).
To determine the statistical significance of the parameter
estimates, we simultaneously estimated the joint effects using
237
maximum likelihood estimation in AMOS. Our overall struc-
tural model exhibited high goodness of fit (w2(92) ¼ 171.49, p
< .01; comparative fit index ¼ .98; incremental fit index ¼ .98;
Tucker–Lewis index ¼ .97; root mean square error of approx-
imation ¼ .05; standardized root mean square residual ¼ .05).
The moderating effect of body weight exposure cues is positive
and significant on the relationship between BMI and antici-
pated devaluation (b ¼ .11, p ¼ .04). The path between antici-
pated devaluation and likelihood to enroll was not significant
(b ¼ .05, p ¼ .26) but was significant for interest in high risk-
reward products (b ¼ .24, p < .001). The path between antici-
pated empowerment and likelihood to enroll (b ¼ .52, p ¼
.001) was significant. It was also significant for interest in high
risk–reward products (b ¼ .16, p ¼ .01) (see Table 3 and
Figure 4).
Moderated mediation analysis. To test whether the BMI by expo-
sure cue interaction on consumption is mediated by antici-
pated devaluation and/or anticipated empowerment, we
estimate conditional indirect effects in AMOS using Hayes’s
(2015) recommendations. This allows us to test the indirect
effect of BMI (stigma source) through social devaluation
dependent on whether the participant’s weight was exposed
while simultaneously estimating the effect of anticipated
empowerment (and vice versa), which is essential when
investigating simultaneous mediators with proposed opposing
effects. When BMI is at potentially stigmatizing levels
(þ1SD, BMI ¼ 34.32), weight exposure (versus no exposure)
increases anticipated devaluation, which then increases inter-
est in high risk–reward products (a  b ¼ .74, 95% CI: [.139,
1.69]). At low levels (1SD BMI ¼ 18.62), the effects are
weaker (a  b ¼ .44, 95% CI: [.092, 1.02]), providing evi-
dence for H1c. The other mediation effects are nonsignificant
(see Table 3).
Exploring the role of manipulative intent as a distal mediator. In this
study, anticipated social devaluation does not reduce likelihood
that participants would join the wellness program. One possi-
bility for this surprising finding is a spillover effect, such that
consumers’ beliefs that the audience will be unfavorable
toward them spill over to create suspicion of the advertisers’
intentions, which then might impact their likelihood to join. We
tested this explanation with an alternative model that includes
participants’ assessments of manipulative intent of the ad as a
distal mediator such that, conditional on the presence of body
weight exposure cues in the advertisement for the wellness
program, BMI is expected to influence anticipated social deva-
luation, which then influences perceptions of the marketer’s
manipulative intent to ultimately affect likelihood to enroll.
Indeed, we find a significant moderated mediation effect for
the highest-order interaction for likelihood to enroll (a  b  c
¼ .004, 90% CI: [.011, .001]). Body weight exposure is
more relevant to consumers’ likelihood to enroll when consu-
mers’ BMIs are highly stigmatizing, and this effect is mediated
by anticipated devaluation, which impacts their assessments of
manipulative intent of the ad (þ1SD, BMI ¼ 34.32) (a  b  c
238 Journal of Marketing Research 58(2)

Table 3. Study 3 Results: Effects of Stigma and Audience Cues on Beneficial and Detrimental Consumption.
Panel A: Structural Model ␤ t-Value p-Value
Moderating Effects of Stigma Exposure Cues
Consumer BMI (potential stigma source)  weight exposure cue ! anticipated social devaluation .11* 2.08 .04
Consumer BMI (potential stigma source)  weight exposure cue ! anticipated empowerment –.01 .15 .89
Effects of Mediating Mechanisms on Beneficial and Detrimental Consumption Behaviors
Consumer anticipated social devaluation ! likelihood to enroll in health care program .05 1.14 .26
Consumer anticipated social devaluation ! interest in high return-risk products .24** 4.16 .001
Consumer anticipated empowerment ! likelihood to enroll in health care program .52** 10.77 .001
Consumer anticipated empowerment ! interest in high return-risk products .16** 2.82 .01
Effects of Stigmatizing Attribute on Mediating Mechanisms
Consumer BMI (potential stigma source) ! consumer anticipated social devaluation .11* 2.13 .03
Consumer BMI (potential stigma source) ! consumer anticipated empowerment –.02 .29 .77
Controls
Weight exposure cue ! anticipated social devaluation .06 1.12 .27
Weight exposure cue ! anticipated empowerment –.12* 2.36 .02
Consumer gender ! anticipated social devaluation –.06 1.18 .24
Consumer gender ! anticipated empowerment –.14** 2.76 .01
Consumer race ! anticipated social devaluation –.16** 3.10 .01
Consumer race ! anticipated empowerment –.18** 3.39 .01
Weight exposure cue ! likelihood to enroll in health care program –.18** 4.05 .001
Weight exposure cue ! high return-risk product interest –.02 .46 .67
Consumer gender ! likelihood to enroll in health care program .03 .68 .50
Consumer gender ! high return-risk product interest –.05 .28 .78
Consumer race ! likelihood to enroll in health care program –.11** 2.53 .01
Consumer race ! high return-risk product interest –.18** 3.23 .001
Panel B: Moderated Mediation Analysis ␤ LLCI ULCI
Index of Moderated Mediation of Conditional Indirect Effects of Stigma on Consumption Based on Stigma Exposure Cues
Consumer BMI (potential stigma source)  weight exposure cue ! anticipated social devaluation ! likelihood .002 –.001 .011
to enroll in health care program
Consumer BMI (potential stigma source)  weight exposure cue ! anticipated social devaluation ! interest .019 .003 .046
in high return-risk products
Consumer BMI (potential stigma source)  weight exposure cue ! anticipated empowerment ! likelihood –.002 –.020 .020
to enroll in health care program
Consumer BMI (potential stigma source)  weight exposure cue ! anticipated empowerment ! interest in –.001 –.012 .010
high return-risk products
R2 for anticipated social devaluation .05
R2 for anticipated empowerment .08
R2 for likelihood to enroll in health care program .36
R2 for interest in high return–risk products .15

Notes: BMI ¼ body mass index; b represents standardized path coefficient. N ¼ 389. Model fit: w2(92) ¼ 171.49, p < .001; comparative fit index ¼ .98; incremental
fit index ¼ .98; Tucker–Lewis index ¼ .97; root mean square error of approximation ¼ .05; standardized root mean square residual ¼ .05.
*p < .05.
**p < .01.

¼ .22, 90% CI: [.021, .681]). This effect is significantly weaker
at low levels (1SD, BMI ¼ 18.62) (a  b  c ¼ .13, 90% CI:
[.013, .396]).9
9
All hypothesized effects remain marginally significant (p ¼ .06) when we
removed covariates from the model. As a robustness test, we also examined
the serial mediation with interest in high return–risk products. We observed a
significant moderated mediation effect for the highest interaction when testing
BMI’s effect on interest in high risk–reward products through anticipated
devaluation and then manipulative intent moderated by body weight exposure
cues (a  b  c ¼ .009, 90% CI: [.023, .001]). Anticipated devaluation and
its impact on manipulative intent exerted a stronger mediating effect when BMI
reached a potentially stigmatizing level (þ1SD, BMI ¼ 34.32) (a  b  c ¼ .12,
90% CI: [.025, .328]) and a weaker effect at low levels (1SD BMI ¼ 18.62) (a
 b  c ¼ .18, 90% CI: [.024, .535]).
This study provides further validation that the effects we
observe are not just audience effects, but “stigma audience”
effects, which require exposure of the potentially stigmatizing
attribute to others. When we hold the audience cue constant,
consumers with potentially stigmatizing BMIs respond less
favorably to marketing communications that signal their body
will be exposed to an audience during consumption, relative to
those that are not exposed. Consumers with weights at levels
that are not stigmatizing respond indifferently to weight expo-
sure or no weight exposure.
The results provide additional support for our theorizing and
a more holistic view of consumers’ decision-making processes
that includes assessments of both opportunities and threats
relative to the stigmatizing attribute. Consumers with
Harmeling et al. 239

Marketing
Communication Characteristic

Body weight
exposure cues
(exposed, not)

Consumer Inferences Consumption Outcomes

.11*
.05 Beneficial Consumption
Consumer anticipated
.11* Consumer likelihood to enroll in
social devaluation
.52** health care program

Consumer BMI
(Stigma source; .24**
−.01
High, low) Detrimental Consumption
−.02
Consumer
anticipated empowerment .16**
Consumer high return–risk
purchase interest

Figure 4. Study 3 results: effects of stigma on consumers’ beneficial and detrimental responses to marketing communications.
Notes: All effects represent the standardized coefficients. Other effects tested in the model were body weight exposure cues, gender, and race as controls on both
mediators and outcomes.
*p ¼ .05.
**p ¼ .01.

potentially stigmatizing weight generate audience inferences,
which in Study 3 were amplified when their weight was
exposed to others; the main requirement for an “audience” to
exist. This finding cannot be explained by homophily alone,
which would predict consistent effects across all conditions
since similarity is held constant (Naylor, Lamberton, and Nor-
ton 2011). It provides evidence that anticipated social devalua-
tion mediates the effect of a stigma on consumer responses to
marketing communications. Although empowerment seemed
unaffected by whether the focal attribute was visible to others,
it emerged as the primary determinant of enrollment intentions.
Study 4: Test of Process by Moderation,
Manipulating Audience Intentions
Audience attribute cues—explicitly defining the potential audi-
ence as possessing the same disease or not (Study 1), photos of
a thin or heavy co-consumer (Study 2)—provide a baseline
from which consumers can estimate an audience’s intentions
in light of the stigmatizing attribute. These inferences inher-
ently contain some level of uncertainty that likely affects deci-
sion making. As demonstrated in Study 2, if a consumer is
managing a stigmatizing attribute, even if an audience cue
signals a shared attribute, they may show greater interest in
detrimental behaviors. This may be due to the remaining ambi-
guity associated with potentially hidden intentions of the audi-
ence. In each of the previous studies, all audience attribute cues
were accompanied by word choices (Study 1: “community of
people who care . . . I look forward to welcoming you”; Study
2: “friendly” staff members; Study 3: “Support Group,” “Get
help . . . ,” and “support in a nurturing setting”) that may have
guided participants’ inferences about the benevolence of the
audiences’ intentions toward them. Theoretically, this would
have skewed consumers to infer more benevolent intentions of
the potential audience than if these words were not present.
Yet, even with these benevolent words we find consistent evi-
dence that consumers inferences of social devaluation vary
based on the audience attribute cue they view.
In Study 4, we examine our proposed process further by
testing whether more direct audience intention cues (i.e., ben-
evolent words vs. neutral word choices) are necessary for con-
sumers to make favorable assessments of audience attribute
cues. If removing these direct intention cues in conditions when
the attribute cue would signal a more favorable audience
(shared attribute cue) reduces consumers positive response,
then this suggests that for consumers managing stigmas, their
main priorities for identifying similarity to the audience is to
estimate people’s intentions of them, providing further support
of H1c.
Study 4: Design, Participants, and Procedure
In Study 4 we partnered with the same health care firm from
Study 1 that provided access to consumers diagnosed with a
variety of diseases (e.g., HIV, cancer, rheumatoid arthritis). We
analyze the click-through effectiveness of various marketing
communications, contingent on the degree to which a consu-
mer’s disease is stigmatizing. We employed a 2 (audience
attribute cue: shared vs. unshared, ambiguous)  2 (audience
intention cue: benevolent vs. neutral)  measured (disease-
240
related stigma) design. For the field experiment, we assigned
participants to conditions using stratified random sampling by
disease, to ensure each disease was equally likely to appear in
each experimental condition. The sample includes all 970 con-
sumers who received and opened an email solicitation from the
company that promoted the online health care program.
Field study participants received an email with the company
name and logo, in which we manipulated audience attribute
cues (email sender as either a community member suffering
from a disease (shared) or a manager of the health care program
(unshared, ambiguous). We manipulated audience intentions
cues as benevolent or neutral. We manipulated audience attri-
bute cue [shared / unshared, ambiguous] shown here with ita-
lics and audience intention cue [benevolent/neutral] shown
here in square brackets. The email read:
Thanks for signing up to learn about opportunities to [connect with
others / exchange information] about your personal health experi-
ences. As [a member of the / the Community Manager for] (Com-
pany) community, I’m excited to announce that the new
(Company) online [platform / community] is now up and running!
The online [community / platform] is a place where people can
[connect with a supportive community / exchange information and
insights on how] to treat, manage, and cope with (recipient’s con-
dition). The [community / platform] offers many ways—such as
groups, chats, polls, blogs, and more—for you to connect with
people who [can relate and empathize with / have experience and
information about] what you’re going through. As [a member
myself / the Community Manager] I wanted to personally invite
you to join. By being among the first to join (Company) commu-
nity, you’ll have the opportunity to shape the experience and create
a [community of people who care / platform for learning from
others]. In sum: (Company) Community is a [supportive commu-
nity focused on / great source for the inside scoop about] (recipi-
ent’s condition). Getting started is easy—just click here or on the
button below. I look forward to getting to know you!
(Name), [(Recipient’s condition) Patient / Community Manager]
We captured stigma with the physicians’ ratings from Study
1. The dependent variable is the percentage of participants who
clicked on the Internet link in the invitation email to visit the
online health care program’s website, which we label click-
throughs.
Manipulation test. To test our manipulations, we randomly
assigned 101 participants (MTurk, MAge ¼ 36.91 years, 59
women) to one of the four conditions and asked them to
“imagine you are suffering from an illness that you feel impacts
your life in a meaningful way. At your doctor’s office, you
provided your email address to join a mailing list about the
condition. You receive the following invitation on email.”
After reading the email (from the main study), participants
indicated the extent to which they perceived the audience inten-
tion cue to be benevolent (“The people in this group seem more
focused on” “ . . . a selfish intent / a benevolent intent”;
“ . . . what they can get out of the group / what they could give
to others in the group”; “ . . . caring for themselves / caring for
Journal of Marketing Research 58(2)
others”; “ . . . helping themselves / helping each other”;
“ . . . learning from others / connecting with others”; and
“ . . . exchanging insider information / providing support and
encouragement”; randomized, nine-point bipolar; a ¼ .87).
Participants also responded to the audience attribute cue scale
(“The person sending the email seems: “ . . . like a person who
has the same illness”; “ . . . like someone with the same con-
dition”; “ . . . like a company expert” (R); “ . . . like someone
who works for the company” (R); randomized, 1 ¼ “strongly
disagree,” and 7 ¼ “strongly agree”; a ¼ .84).
An ANOVA on the audience intention cue index reveals
an intention type main effect (MBenevolent ¼ 7.25, MNeutral ¼
6.07; F(1, 97) ¼ 14.94, p < .001). The audience attribute
cue main effect and the interaction are not significant
(Fs < 1). An ANOVA on the audience attribute cue index
reveals an audience attribute main effect (MShared ¼ 4.37,
MAmbiguous ¼ 3.38; F(1, 97) ¼ 16.15, p < .001). The audi-
ence intention cue main effect (p ¼ .25) and the interaction
(F < 1) are not significant.
Study 4: Results and Discussion
A logistic regression analysis of click-through behaviors
includes stigma, audience attribute cues, audience intention
cues, and their higher-order interactions. We find the pre-
dicted three-way interaction (Wald w2 ¼ 4.76, p ¼ .03; Fig-
ure 5); the other effects in the model are not significant (ps >
.59). As expected, for low stigma diseases (1 SD), the audi-
ence attribute  audience intention simple interaction effect is
nonsignificant (a  b ¼ .11, z ¼ .53, p ¼ .60). For highly
stigmatizing diseases (þ1 SD), the audience attribute  audi-
ence intention simple interaction is significant (a  b ¼ .67,
z ¼ 2.69, p ¼ .007).
We test the interaction between the four combinations of
audience-based communications (shared–benevolent, shared–
neutral, ambiguous–benevolent, ambiguous–neutral) and
stigma. We identify the point at which the omnibus interaction
becomes significant, namely, when stigma  2.86 (Hayes and
Montoya 2017). Consumers with highly stigmatizing diseases
(þ1 SD) who receive shared–benevolent audience cues (M ¼
26.67%) click significantly more often than the other groups
(average M ¼ 15.66%; z ¼ 2.69, p ¼ .007), as shown in
Figure 5. These results emerge from a highly conservative test,
because we only changed 9 of 193 words in the audience attri-
bute cue manipulation in this real-world field experiment, and
actual patients used their own email accounts, which provides
additional support for H1c.
Consumers with stigmatizing diseases click on a marketing
communication more when the message source (1) also pos-
sesses a stigmatizing disease (shared audience cue) and (2)
provides cues of the benevolent intentions of the potential
audience; rather than the same benevolent intention cues asso-
ciated with an ambiguous audience and shared audiences asso-
ciated with neutral intentions. We find no effects for consumers
with less stigmatizing diseases. These findings provide addi-
tional support that the effects we observe are due to consumers’
Harmeling et al.
28%
26%
24%
Click-Through Rate (%)
22%
20%
18%
16%
14%
12%
10%
1 2 3 4 5 6
Disease-Related Stigma
Figure 5. Study 4 results (field experiment): analysis of audience attribute cues and audience intention cues by stigma.
Notes: The shaded area indicates the point at which the omnibus analysis of variance becomes significant on the continuous measure of stigma (stigma ¼ 2.86).
inferences of audiences’ intentions and not similarity alone.
These findings also illustrate a “zero miss” strategy for estimat-
ing intentions of anticipated audiences among consumers man-
aging potential stigma in which ambiguity in cues (e.g.,
ambiguous–benevolent) “trigger vigilance for discrimination”
(Major and O’Brien 2005, p. 403). They provide guidance to
managers on how to improve responsiveness among consumers
managing potential stigmas.
General Discussion
Our studies illustrate a robust interactive effect between a con-
sumer’s potentially stigmatizing attribute and audience cues in
marketing communications: certain cues fuel fears of social
devaluation, which decreases beneficial consumption (e.g.,
click-throughs, enrollment intentions, engagement within a
wellness program) and increases detrimental consumption
(high reward–risk products). These findings point to the need
for more nuanced theorizing to explain consumer-marketing
concepts that may operate differently among consumers man-
aging potentially stigmatizing personal attributes; as such, they
enrich marketing theory on stigma, inform managers, and offer
avenues for further research.
Theoretical Contributions
Our findings directly respond to recent calls for marketing
research on stigma (e.g., Chaney, Sanchez, and Maimon
2019; Lamberton 2019; Mirabito et al. 2016; Wooten and
Rank-Christman 2019). They also contribute to research on
power, status, and the judgments of others in the marketplace
(Ratner and Hamilton 2015); homophily (McPherson, Smith-
Lovin, and Cook 2001) and consumer empowerment; and cus-
tomer engagement (Harmeling et al. 2017).
241
Shared audience attribute/
benevolent intentions As disease-related stigma increases
(greater than 2.86), marketing
communications only generate
significantly higher click-throughs
when a shared audience cue is
presented and the intentions of the
audience are also explicitly described
as benevolent.
Ambiguous audience attribute/
intentions not stated
There is no difference among
Shared audience attribute/
these three conditions.
intention not stated
Ambiguous audience attribute/
benevolent intentions
7
Stigma, consumer power, and status. Prior work often focuses on
how consumers improve their status and power (e.g., Dion and
Borraz 2017) but overlooks the inferior status that stigma can
impose on them (Coskuner-Balli and Thompson 2013). By
definition, stigma implies an undesirable position as “the
other” in a social hierarchy, and power rests with those without
the stigma (i.e., the audience). Integrating our findings across
studies, we identify a continuum of threat inferences that con-
sumers managing stigmas make, based on the cues available to
deduce the power differential between them and a potential
audience. This continuum ranges from low threat, shared audi-
ence attribute cues to high threat, unshared (ambiguous or con-
trasting) audience attribute cues. It shows how distinct
audience cues might (inadvertently) undermine consumer
well-being, and it helps reveal a process by which consumers
aim to manage power differentials in the marketplace: they first
use stigma-relevant audience cues to infer their status relative
to a potential audience and then avoid or approach consump-
tion encounters. This is important for marketers to understand,
as marketing communications often deliberately emphasize
negative deviations in stigma-related campaigns (see Web
Appendix F for examples).
Stigma, inferred audiences, and homophily. Homophily suggests
that people tend to seek out those who are “similar” under the
assumption of a reciprocal sense of “liking” (McPherson,
Smith-Lovin, and Cook 2001). We see some evidence of this,
but instead of the expected main effects of audience cues that
homophily would predict, we observe an interaction by the
stigma potential of a given attribute (e.g., disease, BMI). We
find systematic distinctions between consumers who (do not)
have a potentially stigmatizing attribute in how they assess
similarity and how that affects decision making. Consumers
prioritize the potential stigma over other typical sources of
similarity (e.g., gender, race) (Studies 2 and 3); notably, the
242
same attribute (e.g., BMI) does not seem to provide a relevant
point of similarity when the attribute is not stigmatizing.
Thus, we contribute to research on the multidimensionality
of homophily (e.g., Block and Grund 2014; Lin and Lundquist
2013) by showing that similarity must be calibrated to a
highly prioritized attribute—in this case, the stigmatizing
attribute.
We also identify a boundary condition in which mere simi-
larity, even along the prioritized attribute, does not produce the
intended effects: in Study 2, we find that a shared attribute cue
produces more detrimental consumption than the control con-
dition in which the visual attribute cue was removed, counter to
homophily research. This, and the observations in Study 4 in
which we separate similarity (i.e., shared attribute cues) and
favorability (i.e., benevolent intention cue), suggests an impor-
tant distinction from homophily. When consumers possess
potential stigmas, their primary concern may be to reduce
threats rather than maximize benefits, and similarity is just a
proxy for assessing potential threats.
Stigma, empowerment, and consumer engagement. Stigmatizing
attributes might be a source of empowerment (Corrigan, Kosy-
luk, and Rüsch 2013; Shih 2004). Findings in Study 3 suggest
that empowerment can affect consumption decisions. Study 1
also supports the idea that empowerment triggers downstream
effects: we found that consumers with stigmatizing diseases
who joined the health program after receiving a marketing
communication that featured an ambiguous (vs. shared stigma)
audience attribute cue completed 52% fewer engagement beha-
viors (e.g., likes, posts, comments) in the two weeks after the
invitation. Although more research is needed, these initial
insights point to stigma-related empowerment as a potential
platform for a desirable win-win situation that benefits both
stigmatized consumers and firms.
Managerial and Policy Contributions
Explicit descriptions of co-consumers, promotional images,
and the message source in marketing communications all can
function as audience cues relative to a potential stigma. There-
fore, our findings offer direct applications to marketing man-
agement and public policy.
Stigma-related marketing and policy communications. Our findings
suggest three possible communication strategies for alleviating
the negative effects of stigma on consumption. First, as illu-
strated in Study 2, marketers can attempt to remove audience
attribute cues. Even ambiguous audience cues might lead con-
sumers managing stigmas to inferring greater threats, in stark
contrast to consumers not managing stigmas, who are likely to
use ambiguous cues about co-consumers to infer that an audi-
ence will be similar to them (Naylor, Lamberton, and Norton
2011). Second, because audience cues are often unavoidable
(e.g., referral programs, group-based offerings), marketers can
provide signals that the stigmatizing attribute will be concealed
(Study 3). Third, marketers can combine shared audience
Journal of Marketing Research 58(2)
attribute cues with benevolent audience intention cues (Study
4). This is particularly important because it counters the pre-
valent use of aspirational images in marketing campaigns,
which may inadvertently signal a contrasting audience (Study
2). For example, a Google image search of “templates for gym
advertisements” produces 502 images on just the first page,
95% of which feature a physically fit model (see Web Appen-
dix F), which in our studies motivated consumers with BMIs at
stigmatizing levels to pursue potentially detrimental treatments
that promised to quickly alleviate the stigma. This illustration
suggests not only that our findings are nonintuitive, but that
managers also should consider carefully which information
appears in their marketing communications.
Designing offerings and policies with regard to stigma. Study 3
shows that requesting consumers to reveal their otherwise con-
cealable stigma, even to an audience that is presumably similar
to them, can create detrimental effects. This has implications
for product and policy design. The more consistently a partic-
ular cue is tied to a stigma, the greater the risk that it becomes a
stigma marker (Goffman 1963). This insight is crucial for prod-
ucts, consumption practices, and policies designed to reduce or
manage stigmatizing attributes, which might get systematically
linked to that stigma (Adkins and Ozanne 2005). For example,
redeeming coupons or participating in public welfare programs
might signal impoverishment, thereby insinuating a stigma of
poverty, whether it exists or not. The threat of being assigned a
stigma, even if it does not apply, might reduce consumers’
motivation to engage in that consumption (Argo and Main
2008). Marketers should consider the potential for their product
to become symbolic of a stigma, its visibility to others, and
whether exposing stigmatizing personal attributes is necessary.
They might seek to reduce a product’s visibility (e.g., Invisa-
lign for orthodontic issues; Wahl 2005) or minimize its asso-
ciation with the stigma (e.g., birth control pills disguised in
cases that look like cosmetic compacts; Gibbs 2010). Alterna-
tively, marketers could use stigma symbols strategically, to
signal acceptance in subtle ways that are undetectable by con-
sumers without the stigma (Chaney, Sanchez, and Maimon
2019; Shavitt 2019). Our findings lend support to the idea of
having service staff (e.g., health care workers) who possess the
same stigma as consumers in a focal program (e.g., HIV
patients may prefer programs where some health workers are
also HIV positive; www.positiveimpacthealthcenters.org).
Stigma and public policy communications. Our results are relevant
for institutions that influence, communicate, and apply public
policies related to stigma. These institutions (e.g., CDC, World
Health Organization) are particularly legitimizing, and com-
munications emanating from them can quickly influence
beliefs of what is “normal” (Humphreys and Latour 2013). This
standard is the prerequisite for stigmas to emerge. We see
evidence of this in Studies 2 and 3, in which the effects emerge
in line with the categories set by the CDC for abnormal BMIs.
Therefore, policy institutions might (inadvertently) affect
whether and when a stigma emerges. Our research suggests
Harmeling et al.
that a requirement of a stigma is an audience that identifies
those bearing the stigma as the “other.” Clarifying misconcep-
tions of links between a disease and other categorizations of
people (e.g., HIV/sexual orientation, HPV/women) may be an
effective means of alleviating people’s assessments of “other”
and reducing stigma.
Limitations and Research Directions
Our studies have limitations that point to opportunities for
further research. First, Study 1 showed an unexpected positive
effect of an ambiguous audience cue among consumers with
less stigmatizing diseases. This might imply a U-shaped rela-
tionship between stigma and specific targeting (e.g., with no or
high stigma, specific targeting is more effective, but with low
stigma, generic targeting is more effective); an intriguing idea
for further research. Second, Studies 2 and 3 point to another
important topic: high-risk consumption by people with a stig-
matizing attribute. From a consumer well-being lens, our find-
ing that a single advertising image can nudge stigmatized
consumers toward high-risk choices (e.g., surgical procedures)
is noteworthy, and more research on such negative implications
is needed. Third, Study 4 suggests that service providers are
crucial audiences. Research should assess how service employ-
ees respond to consumer stigmas. A related path is to investi-
gate what makes a particular piece of information a “stigma
marker” for different audiences (e.g., co-consumers, service
providers). This notion relates back to managerial decisions
about product design and branding (e.g., might “unbranding”
a product help reduce a product–stigma association?). Fourth,
because stigma inherently entails power, studying how consu-
mers estimate power differentials in new encounters and how it
shapes their decision to pursue the encounter is important.10
Fifth, our studies investigate various forms of ambiguity (e.g.,
along the focal attribute, unspecified similarity) in which a
single cue could produce wide variations in inferences. The
degree and nature of ambiguity in audience cues and its impact
on consumption decision making warrants further investiga-
tion. Sixth, we study consumers who bear a stigma, but others
(e.g., their caregivers, family, friends) could be affected by
mere association (Argo and Main 2008). These close others
may be more acutely aware of discrediting conditions and more
sensitive in their responses on behalf of the stigmatized. More
research is needed to understand such stigma-by-association.
Finally, we narrowed our theory to a single attribute (disease,
weight), but people may simultaneously possess multiple
potentially stigmatizing attributes, and their interplay indicates
a fruitful area for further research. In this context, beyond
social devaluation by an audience, self-devaluation by stigma-
tized consumers also may be relevant.
10
For example, Wooten (2006) identifies interesting dimensions (e.g.,
duration, magnitude, type) on which power differentials might vary between
consumers with the stigmatizing attribute and those without it.
243
Associate Editor
Katherine White
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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