Evaluating Intersectionality of Policies and Populations

Abstract

* Abbreviations: e-cigarette — : electronic cigarette T21 — : tobacco 21 Although policies and populations do not occur in isolation, researchers often investigate them as if they do. When variables are one-dimensional (ex, race-ethnicity, rural-urban), statistical models produce outputs that do not represent the real world. Uncovering and addressing health disparities necessitates an approach that captures the complexity of population health.1 Intersectionality embraces the overlap of identities, social positions, and social policies.2 We used this approach when evaluating tobacco control policies related to prenatal smoking and found a significant interaction between women’s race and ethnicity, education, and cigarette taxes. Low-educated white and Black women had the highest prevalence of smoking during pregnancy and were the most responsive to taxes, which in turn, improved birth outcomes.3 Examining the effects by women’s race and ethnicity or, separately, education would not have produced the same conclusions. An underresearched disparity in tobacco control is geographic differences within state boundaries. Adolescents in rural areas have higher levels of tobacco use4–6 and are covered by less comprehensive tobacco control policies.5–7 In this issue of Pediatrics , Dai et al8 examine rural-urban differences in the effect … Address correspondence to Summer Sherburne Hawkins, PhD, MS, McGuinn Hall, School of Social Work, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA 02467. E-mail: summer.hawkins{at}bc.edu