In recent years, the intertwining relationship between societal structures and individual health behaviors has garnered significant scientific attention. Among such behaviors, tobacco use remains a pervasive public health challenge worldwide, often intricately linked with social determinants of health that shape disparities among various population groups. A groundbreaking study led by Figueroa, Sridhar, Jankowski, and their colleagues has illuminated a critical facet of this intricate web: the pathways through which structural stigma impacts tobacco use among young adults in the United States, with a particular focus on differences by sexual orientation and gender identity. This research presents a compelling exploration into how entrenched social biases and institutionalized discrimination create complex barriers influencing health outcomes in marginalized communities.
The study dives deeply into the concept of structural stigma, a form of societal-level discrimination that manifests through entrenched policies, cultural norms, and institutional practices, often producing systemic inequities that disproportionately burden sexual and gender minority (SGM) populations. Unlike interpersonal stigma, which is expressed through personal acts of bias or prejudice, structural stigma is embedded in the very fabric of societal functioning, operating invisibly yet pervasively to restrict resources, opportunities, and protections for stigmatized groups. This macro-level phenomenon, the authors argue, helps explain persistent health disparities that cannot be solely attributed to individual choices or interpersonal discrimination.
Tobacco use, well-established as a leading cause of preventable morbidity and mortality, emerges in this context as more than a mere lifestyle factor. It is a behavioral response embedded within socioecological frameworks where stressors, coping mechanisms, and access to health-promoting resources intersect. For SGM young adults, who frequently navigate heightened levels of stress associated with stigma and discrimination, tobacco use may represent both a coping strategy and a marker of deeper health inequities. By scrutinizing how structural stigma directs these behaviors, the study sheds light on the mechanisms perpetuating tobacco-related health disparities among these vulnerable populations.
Methodologically, the researchers employed a robust multilevel analytical approach, integrating individual-level survey data with comprehensive indices of structural stigma across geographic regions in the United States. By cross-referencing reported tobacco use behaviors with measures such as discriminatory laws, social policies, and cultural attitudes toward sexual orientation and gender identity, the study disentangles the complex pathways linking structural stigma and health behaviors. The inclusion of intersectional identities within the analyses underscores how compounding social disadvantages can amplify risk factors, providing a nuanced portrait of health inequities.
One of the striking findings highlights that young adults identifying as lesbian, gay, bisexual, transgender, or queer demonstrate significantly higher prevalence rates of tobacco use in regions with elevated levels of structural stigma. This pattern suggests that beyond individual psychosocial factors, the broader sociopolitical environment exerts a formidable influence on health risk profiles. Policies that marginalize or exclude SGM individuals contribute to entrenched stress, social isolation, and reduced access to affirming healthcare, collectively fostering conditions conducive to tobacco use initiation and persistence.
Further examination reveals that structural stigma influences not only the likelihood of tobacco use but also access to cessation resources and support systems. In states where discriminatory policies prevail, tobacco control programs are often less inclusive or accessible for SGM populations, undermining their effectiveness. This finding signals an urgent need for public health interventions that account for structural determinants and prioritize inclusivity in program design and policy advocacy.
The implications extend beyond tobacco use, reflecting broader patterns of health inequities rooted in systemic discrimination. Structural stigma’s impact on mental health, substance use, and chronic disease risk factors has been documented, and this study reinforces the notion that addressing societal-level barriers is indispensable for meaningful progress in health equity. Moreover, the researchers’ work calls for heightened attention to legislative and policy reforms as critical components of comprehensive public health strategies targeting marginalized youth.
Importantly, the study also explores variations within the SGM community, discerning differences in tobacco use behaviors and responses to structural stigma based on specific sexual orientations and gender identities. This intragroup analysis unveils that transgender and nonbinary individuals may face unique vulnerabilities, often compounded by intersecting forms of marginalization such as race, socioeconomic status, and geographic location. These intersections necessitate tailored interventions that recognize the heterogeneity within SGM populations and the multifactorial nature of stigma.
The researchers advocate for integrating structural stigma metrics into public health surveillance systems and tobacco control programs, enabling more precise identification of high-risk environments and populations. By mapping the landscape of social inequities alongside health behaviors, policymakers and practitioners can better allocate resources and design targeted interventions that disrupt the pathways from stigma to poor health outcomes.
Contemporary tobacco control efforts have achieved significant successes in the general population; however, as this study demonstrates, these gains are often unevenly distributed. Structural stigma acts as an insidious barrier to equitable health improvements, underscoring the importance of sociopolitical context in shaping disease burden. The call to action emanating from this research is clear: dismantling structural stigma must be central to efforts aimed at reducing tobacco use disparities and advancing health equity for all young adults.
To achieve these goals, multidisciplinary collaborations between public health professionals, policymakers, legal advocates, and community stakeholders are essential. Advocacy for inclusive policies that protect sexual and gender minority rights, coupled with culturally competent health promotion programs, can foster environments that discourage tobacco use and support cessation. Furthermore, ongoing research must continue to unravel the causal pathways linking structural factors to health behaviors, informing adaptive and responsive interventions.
In sum, this landmark study by Figueroa and colleagues represents a vital contribution to our understanding of the systemic roots of tobacco-related health inequities. By spotlighting the insidious role of structural stigma and its differential impact within the diverse SGM community, the authors provide a roadmap for comprehensive strategies that transcend individual behavior change, addressing the foundational social determinants of health. Their work not only advances scientific knowledge but also galvanizes action toward a more just and healthy society where all young adults can thrive free from the burdens of discrimination and its health consequences.
The findings resonate beyond tobacco control, offering a paradigm for examining structural stigma’s impact across various health domains and populations. As structural determinants gain recognition as pivotal drivers of health disparities, integrating this perspective into public health research and practice will be paramount. This study exemplifies the critical blend of rigorous methodology, theoretical grounding, and social justice orientation necessary to tackle complex health inequities in the 21st century.
Ultimately, addressing structural stigma requires concerted societal transformation alongside targeted health interventions. Policies that affirm and protect sexual and gender minorities, public education campaigns challenging stigma, and resource allocation for inclusive support services collectively contribute to dismantling the systemic barriers illuminated by this research. Through such collective efforts, the aspiration for equitable tobacco control and health outcomes among all young adults in the United States can move closer to realization.
Subject of Research: The study investigates how structural stigma influences tobacco use behaviors among young adults in the United States, particularly focusing on differences by sexual orientation and gender identity.
Article Title: Examining pathways between structural stigma and tobacco use: a comparison among young adults living in the United States by sexual orientation and gender identity.
Article References:
Figueroa, W., Sridhar, S., Jankowski, E. et al. Examining pathways between structural stigma and tobacco use: a comparison among young adults living in the United States by sexual orientation and gender identity. Int J Equity Health 24, 128 (2025). https://doi.org/10.1186/s12939-025-02487-2
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