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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Research

What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults

Authors: Nada Amroussia, Jennifer L. Pearson, Per E. Gustafsson

Published in: International Journal for Equity in Health | Issue 1/2019

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Abstract

Background

Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; however, there is a lack of research examining the social processes driving these complex inequalities. Using an intersectional framework, the current study examines key processes contributing to inequalities in smoking between four intersectional groups by education and sexual orientation.

Methods

The sample (28,362 adults) was obtained from Wave 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. Four intersectional positions were created by education (high- and low-education) and sexual orientation (heterosexual or lesbian, gay, bisexual, or queer/questioning (LGBQ). The joint inequality, the referent socio-economic inequality, and the referent sexual orientation inequality in smoking were decomposed by demographic, material, tobacco marketing-related, and psychosocial factors using non-linear Oaxaca decomposition.

Results

Material conditions made the largest contribution to the joint inequality (9.8 percentage points (p.p.), 140.9%), referent socio-economic inequality (10.01 p.p., 128.4%), and referent sexual orientation inequality (4.91 p.p., 59.8%), driven by annual household income. Psychosocial factors made the second largest contributions to the joint inequality (2.12 p.p., 30.3%), referent socio-economic inequality (2.23 p.p., 28.9%), and referent sexual orientation inequality (1.68 p.p., 20.5%). Referent sexual orientation inequality was also explained by marital status (20.3%) and targeted tobacco marketing (11.3%).

Conclusion

The study highlights the pervasive role of material conditions in inequalities in cigarette smoking across multiple dimensions of advantage and disadvantage. This points to the importance of addressing material disadvantage to reduce combined socioeconomic and sexual orientation inequalities in cigarette smoking.
Literature
1.
Drope J, Liber AC, Cahn Z, Stoklosa M, Kennedy R, Douglas CE, Henson R, Drope J. Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States. CA Cancer J Clin. 2018;68(2):106–15.PubMedCrossRef
2.
3.
4.
Pampel F, Legleye S, Goffette C, Piontek D, Kraus L, Khlat M. Cohort changes in educational disparities in smoking: France, Germany and the United States. Soc Sci Med. 2015;127:41–50.PubMedCrossRef
5.
Wang TW, Asman K, Gentzke AS, Cullen KA, Holder-Hayes E, Reyes-Guzman C, Jamal A, Neff L, King BA. Tobacco product use among adults—United States, 2017. Morb Mortal Wkly Rep. 2018;67(44):1225.CrossRef
6.
McCabe SE, Matthews AK, Lee JG, Veliz P, Hughes TL, Boyd CJ. Tobacco use and sexual orientation in a National Cross-sectional Study: age, race/ethnicity, and sexual identity–attraction differences. Am J Prev Med. 2018;54(6):736–45.PubMedPubMedCentralCrossRef
7.
Wheldon CW, Kaufman AR, Kasza KA, Moser RP. Tobacco use among adults by sexual orientation: findings from the population assessment of tobacco and health study. LGBT health. 2018;5(1):33–44.PubMedPubMedCentralCrossRef
8.
Rosario M, Li F, Wypij D, Roberts AL, Corliss HL, Charlton BM, Frazier AL, Austin SB. Disparities by sexual orientation in frequent engagement in cancer-related risk behaviors: a 12-year follow-up. Am J Public Health. 2016;106(4):698–706.PubMedPubMedCentralCrossRef
9.
Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: part I—all cancers and lung cancer and part II—colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol. 2011;2011:107497.PubMedCrossRef
10.
Matthews AK, Hotton A, DuBois S, Fingerhut D, Kuhns LM. Demographic, psychosocial, and contextual correlates of tobacco use in sexual minority women. Res Nurs Health. 2011;34(2):141–52.PubMed
11.
Pelster AD, Fisher CM, Irwin JA, Coleman JD, McCarthy MA. Tobacco use and its relationship to social determinants of health in LGBT populations of a Midwestern state. LGBT Health. 2015;2(1):71–6.PubMedCrossRef
12.
Jannat-Khah DP, Dill LJ, Reynolds SA, Joseph MA. Stress, socializing, and other motivations for smoking among the lesbian, gay, bisexual, transgender, and queer community in new York City. Am J Health Promot. 2018;32(5):1178–86.PubMedCrossRef
13.
Hughes TL, Johnson TP, Matthews AK. Sexual orientation and smoking: results from a multisite women's health study. Subst Use Misuse. 2008;43(8–9):1218–39.PubMedPubMedCentralCrossRef
14.
Blosnich J, Lee JG, Horn K. A systematic review of the aetiology of tobacco disparities for sexual minorities. Tob Control. 2013;22(2):66–73.PubMedCrossRef
15.
Balsam KF, Beadnell B, Riggs KR. Understanding sexual orientation health disparities in smoking: a population-based analysis. Am J Orthopsychiatry. 2012;82(4):482.PubMedCrossRef
16.
Kim JE, Tsoh JY. Cigarette Smoking Among Socioeconomically Disadvantaged Young Adults in Association With Food Insecurity and Other Factors. Prev Chron Dis. 2016;13:E08.
17.
Martinez SA, Beebe LA, Thompson DM, Wagener TL, Terrell DR, Campbell JE. A structural equation modeling approach to understanding pathways that connect socioeconomic status and smoking. PLoS One. 2018;13(2):e0192451.PubMedPubMedCentralCrossRef
18.
Richman LS, Zucker A. Quantifying intersectionality: an important advancement for health inequality research. Soc Sci Med. 2019;226:246–8.PubMedCrossRef
19.
Jackson JW, VanderWeele TJ. Intersectional decomposition analysis with differential exposure, effects, and construct. Soc Sci Med. 2019;226:254–9.PubMedCrossRef
20.
Evans CR. Adding interactions to models of intersectional health inequalities: comparing multilevel and conventional methods. Soc Sci Med. 2019;221:95–105.PubMedCrossRef
21.
Bauer GR. Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Soc Sci Med. 2014;110:10–7.PubMedCrossRef
22.
Corliss HL, Rosario M, Birkett MA, Newcomb ME, Buchting FO, Matthews AK. Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age. Am J Public Health. 2014;104(6):1137–47.PubMedPubMedCentralCrossRef
23.
Hsieh N, Ruther M. Sexual minority health and health risk factors: intersection effects of gender, race, and sexual identity. Am J Prev Med. 2016;50(6):746–55.PubMedPubMedCentralCrossRef
24.
Wheldon CW, Watson RJ, Fish JN, Gamarel K. Cigarette Smoking Among Youth at the Intersection of Sexual Orientation and Gender Identity. LGBT health. 2019;6(5):235-41.PubMedCrossRef
25.
Casetta B, Videla AJ, Bardach A, Morello P, Soto N, Lee K, Camacho PA, Hermoza Moquillaza RV, Ciapponi A. Association between cigarette smoking prevalence and income level: a systematic review and meta-analysis. Nicotine Tob Res. 2016;19(12):1401–7.
26.
Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, Nyman JA, Fu SS. Associations between smoking behaviors and financial stress among low-income smokers. Prev Med Rep. 2015;2:911–5.PubMedPubMedCentralCrossRef
27.
Brown-Johnson CG, England LJ, Glantz SA, Ling PM. Tobacco industry marketing to low socioeconomic status women in the USA. Tobacco control. 2014;23(e2):e139-46.PubMedPubMedCentralCrossRef
28.
Lee JG, Henriksen L, Rose SW, Moreland-Russell S, Ribisl KM. A systematic review of neighborhood disparities in point-of-sale tobacco marketing. Am J Public Health. 2015;105(9):e8–18.PubMedPubMedCentralCrossRef
29.
Emory K, Buchting FO, Trinidad DR, Vera L, Emery SL. Lesbian, gay, bisexual, and transgender (LGBT) view it differently than non-LGBT: exposure to tobacco-related couponing, e-cigarette advertisements, and anti-tobacco messages on social and traditional media. Nicotine Tob Res. 2018;21(4):513-22.CrossRef
30.
Dilley JA, Spigner C, Boysun MJ, Dent CW, Pizacani BA. Does tobacco industry marketing excessively impact lesbian, gay and bisexual communities? Tob Control. 2008;17(6):385-90.PubMedCrossRef
31.
Gustafsson PE, Sebastian MS, Mosquera PA. Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden. Glob Health Action. 2016;9(1):32819.PubMedCrossRef
32.
Sinning M, Hahn M, Bauer TK. The blinder-Oaxaca decomposition for nonlinear regression models. Stata J. 2008;8(4):480–92.CrossRef
33.
Hyland A, Ambrose BK, Conway KP, Borek N, Lambert E, Carusi C, Taylor K, Crosse S, Fong GT, Cummings KM, Abrams D. Design and methods of the population assessment of tobacco and health (PATH) study. Tob Control. 2017;26(4):371–8.PubMedCrossRef
34.
United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse, and United States Department of Health and Human Services. Food and Drug Administration. Center for Tobacco Products. Population Assessment of Tobacco and Health (PATH) Study [United States] Public-Use Files, User Guide. ICPSR36498-v6. Ann Arbor: Inter-university Consortium for Political and Social Research [distributor]; 2017. https://​doi.​org/​10.​3886/​ICPSR36498.​userguide34.
35.
Jackson JW, Williams DR, VanderWeele TJ. Disparities at the intersection of marginalized groups. Soc Psychiatry Psychiatr Epidemiol. 2016;51(10):1349–59.PubMedPubMedCentralCrossRef
36.
United States Department of Health andHuman Services. National Institutes ofHealth. National Institute on Drug Abuse, United States Department of Health andHuman Services. Food and DrugAdministration. Center for TobaccoProducts. Population Assessment of Tobaccoand Health (PATH) Study [UnitedStates] Public-Use Files. Codebook for Wave 2: Adult Data. Population Assessment of Tobaccoand Health (PATH) Study [UnitedStates] Public-Use Files. Codebook for Wave 2: Adult Data.
37.
Emory K, Kim Y, Buchting F, Vera L, Huang J, Emery SL. Intragroup variance in lesbian, gay, and bisexual tobacco use behaviors: evidence that subgroups matter, notably bisexual women. Nicotine Tob Res. 2015;18(6):1494–501.PubMedPubMedCentralCrossRef
38.
Alves J, Kunst AE, Perelman J. Evolution of socioeconomic inequalities in smoking: results from the Portuguese national health interview surveys. BMC Public Health. 2015;15(1):311.PubMedPubMedCentralCrossRef
39.
Siegel M. Measuring age-specific variations in income-related inequalities in smoking behavior in Germany. Health Psychol Behav Med. 2014;2(1):412–23.PubMedPubMedCentralCrossRef
40.
Ortiz KS, Duncan DT, Blosnich JR, Salloum RG, Battle J. Smoking among sexual minorities: are there racial differences? Nicotine Tob Res. 2015;17(11):1362–8.PubMedCrossRef
41.
Ramsey MW Jr, Chen-Sankey JC, Reese-Smith J, Choi K. Association between marital status and cigarette smoking: variation by race and ethnicity. Prev Med. 2019;119:48–51.PubMedCrossRef
42.
Lindström M. Social capital, economic conditions, marital status and daily smoking: a population-based study. Public Health. 2010;124(2):71–7.PubMedCrossRef
43.
Midi H, Sarkar SK, Rana S. Collinearity diagnostics of binary logistic regression model. J Interdisciplinary Mathematics. 2010;13(3):253–67.CrossRef
44.
Jann B. The blinder–Oaxaca decomposition for linear regression models. Stata J. 2008;8(4):453–79.CrossRef
45.
46.
Oaxaca R. Male-female wage differentials in urban labor markets. Int Econ Rev. 1973;1:693–709.CrossRef
47.
Yun MS. Decomposing differences in the first moment. Econ Lett. 2004;82(2):275–80.CrossRef
48.
Moor I, Spallek J, Richter M. Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. J Epidemiol Community Health. 2017;71(6):565–75.PubMedCrossRef
49.
Skalická V, Van Lenthe F, Bambra C, Krokstad S, Mackenbach J. Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study. Int J Epidemiol. 2009;38(5):1272–84.PubMedCrossRef
50.
51.
52.
Gustafsson PE, Linander I, Mosquera PA. Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in northern Sweden. Int J Equity Health. 2017;16(1):22.PubMedPubMedCentralCrossRef
53.
Fallin A, Davis B. LGBT organisation successfully advocated for ban on tobacco promotions in San Jose, California. Tobacco Control. 2016;25(5):504–5.PubMedCrossRef
54.
Mallon GP. Oh, Canada: the experience of working-class gay men in Toronto. J Gay Lesbian Soc Serv. 2001;12(3–4):103–17.CrossRef
55.
D'Avanzo PA, Halkitis PN, Yu K, Kapadia F. Demographic, mental health, behavioral, and psychosocial factors associated with cigarette smoking status among young men who have sex with men: the P18 cohort study. LGBT Health. 2016;3(5):379–8.PubMedPubMedCentralCrossRef
56.
Demant D, Hides L. WhiteKM, Kavanagh DJ. Effects of participation in and connectedness to the LGBT community on substance use involvement of sexual minority young people. Addict Behav. 2018;81:167–74.PubMedCrossRef
57.
Barnhill M, Lee J, Rafferty A. Health inequities among lesbian, gay, and bisexual adults in North Carolina, 2011–2014. Int J Environ Res Public Health. 2017;14(8):835.PubMedCentralCrossRef
58.
Wintemberg J, McElroy JA, Ge B, Everett KD. Can Smoke-Free Policies Reduce Tobacco Use Disparities of Sexual and Gender Minorities in Missouri? Nicotine Tob Res. 2017;19(11):1308-14.CrossRef
Metadata
Title
What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
Authors
Nada Amroussia
Jennifer L. Pearson
Per E. Gustafsson
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-1015-1

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