HEALTH EQUITY IN TOBACCO CONTROL THROUGH AN INTERSECTIONALITY FRAMEWORK: EXAMINING THE COMPOUNDING EFFECTS OF MINORITY STRESSORS AND TOBACCO ADVERTISING
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Graduate group
Discipline
Public Health
Psychiatry and Psychology
Subject
Intersectionality
Message Effects
Minority Stress
Social Identity
Tobacco Control
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Abstract
The following dissertation is composed of three studies that all investigate how social identity and experiences in the social world, namely exposure to tobacco marketing and minority stressors, influence cigarette smoking. It is well established that smoking cigarettes has negative downstream health consequences, and this dissertation seeks to contribute to our understanding of why there is higher tobacco-related morbidity and mortality for people with marginalized identities who do not necessarily have additional biological risk factors. By examining who has higher exposure to tobacco marketing and minority stressors and how the effects of exposure vary across people with different social identities, the following studies will provide a more comprehensive understanding of how cigarette smoking, and the downstream health consequences are influenced by social and political factors.Study 1 tests the causal link between exposure to images of point-of-sale cigarette promotions and cigarette craving in an online experiment and investigates how that relationship differs by participants’ subjective view of their socioeconomic status. Participants craved cigarettes more after viewing all cigarette promotions (vs. non-smoking cues) and craving was significantly higher after cigarette promotions with a discount (vs. without). Craving was also higher for participants with a lower (vs. higher) subjective social status regardless of cigarette promotion type, while craving was only high for promotions with a discount (vs. without) for participants with higher subjective social status. Study 2 tracked daily exposure to real-time tobacco advertising and stressors over the course of two weeks. Participants felt more stressed and negative on days they experienced interpersonal discrimination, and they had higher cigarette cravings on days they experienced interpersonal discrimination and higher-than-usual tobacco advertising together. Groups of participants with a minoritized sexual identity or marginalized race/ethnicity also experienced more interpersonal discrimination and exposure to tobacco advertising. Study 3 investigated the relationship between sexual identity-based minority stressors and smoking in a sample of women who identify as a sexual minority and how psychological distress and exposure to tobacco promotions interact with that relationship. Participants with a marginalized race or ethnicity experienced more sexual identity-based minority stressors, and minority stressors were positively associated with cigarette smoking, though concealment was negatively associated. There was an indirect effect of victimization on smoking via depression. Experiencing high levels of most minority stressors also amplified the effect of exposure to tobacco promotions on smoking. Taken together, the results indicate both the stress from being marginalized by society and heightened exposure to tobacco advertising contributes to higher smoking prevalence in certain marginalized groups. Policies that restrict tobacco advertising along with creating interventions that offer more support for marginalized groups could reduce health disparities.