Current Cigarette Smoking Inequities Across Intersecting Social Positions in New York State: Incorporating Disability as a Core Dimension

INTRODUCTION: Disability is consistently associated with higher smoking prevalence yet remains largely excluded from intersectional research. This study examined current cigarette smoking inequities among New York State (NYS) adults through an Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, incorporating disability as a core dimension alongside race/ethnicity, gender, age, and education. METHODS: This cross-sectional study analyzed a sample from the 2024 NYS Behavioral Risk Factor Surveillance System (N=38,061). Five social dimensions, including race/ethnicity, gender, age group, education, and disability status, defined 319 intersectional strata. Two-level logistic regression models estimated stratum-level variance, predicted prevalence, and interaction effects. RESULTS: Overall, 11.8% of participants reported current cigarette smoking. Approximately one-fifth of total variance in current cigarette smoking was attributable to between-strata differences, mostly explained by additive main effects, though residual variance remained. Predicted prevalence of current cigarette smoking varied across strata, ranging from 1.5% to 53.8%. The lowest-prevalence strata consisted of racial/ethnic minority college graduates without disability, while the highest-prevalence strata were predominantly non-Hispanic white or Other adults with less than high school education and disability. Ten strata exhibited significant interaction effects, departing from additive predictions. The null model median odds ratio (MOR: 2.44, 95% CI: 2.19, 2.68) revealed substantial between-strata heterogeneity, corresponding to over a twofold difference in odds when comparing two randomly chosen strata ordered by risk. CONCLUSIONS: Cigarette smoking inequities in NYS were patterned by intersecting social positions, with substantial heterogeneity across intersectional strata. Disability appeared consistently among the highest-burden strata, and its combination with low education produced the greatest predicted smoking prevalence.