Abstract
BackgroundSocio-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.MethodsThe 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.ResultsMaterial 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%).ConclusionThe 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.
Highlights
Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; there is a lack of research examining the social processes driving these complex inequalities
The results indicated that the variables included in the models were not highly collinear, with a max variance inflation factors (VIFs) of 1.65, mean VIF of 1.30, and highest VIF displayed by annual household income, marital status, and age (1.65, 1.55, and 1.54 respectively)
High-educated heterosexual adults had the lowest prevalence of cigarette smoking (17.4%), while loweducated heterosexual adults had the highest prevalence of current cigarette smoking (29.7%)
Summary
Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; there is a lack of research examining the social processes driving these complex inequalities. Socio-economic inequalities and sexual orientation inequalities in cigarette smoking have conventionally been understood, studied, and addressed as separate axes of inequalities [10,11,12,13,14,15,16,17] Such a singular and fragmented approach does not capture how these two axes of inequalities interplay to affect adults’ smoking status, as challenged by the framework of intersectionality. Intersectionality assumes that people’s social positions are shaped by interlocking rather than separate axes of power relations stemming from, mutually constructed social factors, including (among others,), sexual orientation, socio-economic status, race, and gender These interlocking power relations create a complex web of social inequalities determining people’s advantage and disadvantage [18,19,20]. According to the intersectional approach, an individual’s experience and his/her health, “are not the sum of their parts” [21]; for example, the health and the implications of being an LGBQ adult differ between low-educated LGBQ adults and high-educated LGBQ adults [21]
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