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What drives us apart?: Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
2019 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 18, article id 109Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 18, article id 109
Keywords [en]
Sexual and Gender minorities, Education, Cigarette smoking, Intersectionality, Health inequality, Blinder-Oaxaca decomposition
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-161895DOI: 10.1186/s12939-019-1015-1ISI: 000475907200001PubMedID: 31315627OAI: oai:DiVA.org:umu-161895DiVA, id: diva2:1341342
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08Bibliographically approved

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Gustafsson, Per E.

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