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

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 contrib...

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Main Authors: Nada Amroussia, Jennifer L. Pearson, Per E. Gustafsson
Format: Article
Language:English
Published: BMC 2019-07-01
Series:International Journal for Equity in Health
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12939-019-1015-1
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author Nada Amroussia
Jennifer L. Pearson
Per E. Gustafsson
author_facet Nada Amroussia
Jennifer L. Pearson
Per E. Gustafsson
author_sort Nada Amroussia
collection DOAJ
description 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.
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spelling doaj.art-241709a6133d40868d009a274b8b874b2022-12-22T01:11:54ZengBMCInternational Journal for Equity in Health1475-92762019-07-0118111410.1186/s12939-019-1015-1What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adultsNada Amroussia0Jennifer L. Pearson1Per E. Gustafsson2Division of Social and Behavioral Health, University of NevadaDivision of Social and Behavioral Health/Health Administration and Policy, University of NevadaDepartment of Public Health and Clinical Medicine, Umeå UniversityAbstract 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.http://link.springer.com/article/10.1186/s12939-019-1015-1Sexual and Gender minoritiesEducationCigarette smokingIntersectionalityHealth inequalityBlinder-Oaxaca decomposition
spellingShingle Nada Amroussia
Jennifer L. Pearson
Per E. Gustafsson
What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
International Journal for Equity in Health
Sexual and Gender minorities
Education
Cigarette smoking
Intersectionality
Health inequality
Blinder-Oaxaca decomposition
title What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
title_full What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
title_fullStr What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
title_full_unstemmed What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
title_short What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
title_sort what drives us apart decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among u s adults
topic Sexual and Gender minorities
Education
Cigarette smoking
Intersectionality
Health inequality
Blinder-Oaxaca decomposition
url http://link.springer.com/article/10.1186/s12939-019-1015-1
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