Cigarette Smoking in Same-Sex and Different-Sex Unions: The Role of Socioeconomic and Psychological Factors

Abstract

Cigarette smoking has long been a target of public health intervention because it substantially contributes to morbidity and mortality. Individuals in different-sex marriages have lower smoking risk (i.e., prevalence and frequency) than different-sex cohabiters. However, little is known about the smoking risk of individuals in same-sex cohabiting unions. We compare the smoking risk of individuals in different-sex marriages, same-sex cohabiting unions, and different-sex cohabiting unions using pooled cross-sectional data from the 1997–2010 National Health Interview Surveys (N = 168,514). We further examine the role of socioeconomic status (SES) and psychological distress in the relationship between union status and smoking. Estimates from multinomial logistic regression models reveal that same-sex and different-sex cohabiters experience similar smoking risk when compared to one another, and higher smoking risk when compared to the different-sex married. Results suggest that SES and psychological distress factors cannot fully explain smoking differences between the different-sex married and same-sex and different-sex cohabiting groups. Moreover, without same-sex cohabiter’s education advantage, same-sex cohabiters would experience even greater smoking risk relative to the different-sex married. Policy recommendations to reduce smoking disparities among same-sex and different-sex cohabiters are discussed.

Disparities in Health and Disability Among Older Adults in Same-Sex Cohabiting Relationships

“…The NHIS has been used in prior research to examine health disparities for younger adults in co-residential same-sex relationships (Heck, Sell, & Gorin, 2006; Cochran & Mays, 2012; Liu, Reczek & Brown, 2013; Reczek, Liu & Brown, 2013) and has not been utilized to examine differences in health or disability status among older adults. Consistent with studies on older LGB adults (Fredricksen-Goldsen, et al, 2011; 2013a; 2013b; Wallace et al ., 2011), we restrict our sample to older, cohabiting, partnered adults 50 years and older in the NHIS.…”

Self-rated health at the intersection of sexual identity and union status

“…According to fundamental cause theory, the health disparities of gay and lesbian individuals are due, in part, to social stigma and historically unequal access to legal and institutional benefits of marriage that contribute to socioeconomic disadvantage; socioeconomic disadvantage is in turn associated with increased stress, psychological distress, and worse self-rated health (Hatzenbuelher, McLaughlin, Keyes, & Hasin, 2010; Meyer, 2003a,b). Several studies show that SES also appears to play a role in differences between same-sex cohabiting couples and their different-sex married and cohabiting counterparts on both self-rated health and health behavior (Denney et al, 2013; Liu et al, 2013; Reczek, Liu, & Brown, 2014; Reczek, Liu, & Spiker, 2014). For example, Liu and colleagues found that the same-sex cohabiting were disadvantaged in health relative to the different-sex married, but that the same-sex cohabiting’s higher SES actually protected them from even worse relative self-rated health.…”

The Health Disparities of Same-sex Cohabitors at the Intersection of Race-ethnicity and Gender

“…These patterns appear to extend to same-sex cohabitors, wherein single groups have better health than same-sex cohabiting groups as a result of selection and resources. In addition, higher rates of substance use among same-sex cohabiting women across all racial-ethnic groups than their unpartnered single counterparts may reflect the overall higher rates of substance use among those in the lesbian community (Reczek et al 2014; Rothblum and Solovay 2009); relative to single women, who appear healthier, all racial-ethnic same-sex cohabiting groups may experience a disadvantage. Same-sex cohabiting women’s greater substance use may also be exacerbated by being in a same-sex cohabitating relationship as a result of convergence processes (Reczek et al 2014), wherein partners of the same sex promote unhealthy behavior in one another.…”

“…For example, it may be that cohabitors in this sample define themselves as married as a symbolic act (Reczek et al 2009), or were legally married in a state that allows same-sex marriage (e.g., Massachusetts), but lived in another state and receive no institutional benefits from this marriage (Rosenfeld 2007). This implies a possible conflation of the same-sex married and cohabiting; thus, we follow previous studies (e.g., Denney et al 2013; Liu et al 2013; Reczek et al 2014) to combine them into one group. Notably, the NHIS did not collect data on sexual orientation until 2013, so we are unable to identify gay and lesbian respondents who are not in cohabiting relationships for a majority of the study years.…”

“…Despite inroads in our understanding of how union status differences in health vary across gender, race-ethnicity, or sexual minority status, previous research is limited in that it either examines these factors in isolation or focuses on the intersection of only two factors at a time (e.g., gender along with race-ethnicity, sexual minority status along with gender, or union status along with gender or race) (e.g., Gorman, Denney, Dowdy, and Medeiros 2015; Read and Gorman 2006; Reczek, Liu, and Brown 2014). Veenstra (2011, 2013) examines the intersection of gender, race and sexual minority status in producing health outcomes and finds significant evidence for the intersectional processes of these statuses, yet these studies did not consider the important context of union status.…”