Moderate-to-Severe Tobacco Use Disorder and Discrimination Among U.S. Sexual Minority Older Adults

Luisa Kcomt; Rebecca J Evans-Polce; Curtiss W Engstrom; Brady T West; Carol J Boyd; Sean Esteban McCabe

doi:10.1093/geronb/gbab067

Moderate-to-Severe Tobacco Use Disorder and Discrimination Among U.S. Sexual Minority Older Adults

J Gerontol B Psychol Sci Soc Sci. 2021 Aug 13;76(7):1400-1407. doi: 10.1093/geronb/gbab067.

Authors

Luisa Kcomt¹, Rebecca J Evans-Polce¹, Curtiss W Engstrom², Brady T West^{1

2

3}, Carol J Boyd^{1

4

5}, Sean Esteban McCabe^{1

2

3

4

6

7}

Affiliations

¹ Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, USA.
² Institute for Social Research, University of Michigan, Ann Arbor, USA.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
⁴ Institute for Research on Women and Gender, University of Michigan, Ann Arbor, USA.
⁵ Addiction Center, Department of Psychiatry, Rachel Upjohn Building, University of Michigan, Ann Arbor, USA.
⁶ Rogel Cancer Center, University of Michigan, Ann Arbor, USA.
⁷ Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, USA.

Abstract

Objectives: The dearth of research on age-related differences in risk factors for tobacco use disorder (TUD) among sexual minorities, particularly among older adults, can obscure the differential needs of sexual minority age groups for tobacco prevention and cessation. We examined the association of cumulative ethnic/racial discrimination and sexual orientation discrimination with moderate-to-severe TUD among U.S. sexual minority adults aged 50 years and older.

Method: We analyzed cross-sectional data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309 U.S. adults). Our sample consisted of 1,258 adults (lesbian/gay-, bisexual-, and heterosexual-identified adults with same-sex attraction/behavior) aged ≥50 years. Multivariable logistic regression analyses estimated the association of cumulative lifetime ethnic/racial discrimination and sexual orientation discrimination with past-year moderate-to-severe TUD and tested whether the association differed for adults aged 50-64 years versus those aged ≥65 years.

Results: An estimated 8.1% of the sample met criteria for moderate-to-severe TUD. Lifetime ethnic/racial discrimination and sexual orientation discrimination was not significantly associated with moderate-to-severe TUD for adults aged ≥50 years. However, a significant 2-way interaction was found between discrimination and age. In age-stratified analyses, greater discrimination was significantly associated with greater risk for moderate-to-severe TUD for adults aged ≥65 years, but not adults aged 50-64 years.

Discussion: Greater cumulative discrimination based on ethnicity/race and sexual orientation was associated with increased risk for moderate-to-severe TUD among sexual minority adults aged ≥65 years. Our findings underscore the importance of age considerations in understanding the role of discrimination in the assessment and treatment of TUD.

Keywords: Age; Discrimination; Sexual minority; Tobacco; Tobacco use disorder.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Cross-Sectional Studies
Homophobia / statistics & numerical data*
Humans
Male
Middle Aged
Racism / statistics & numerical data*
Severity of Illness Index
Sexual and Gender Minorities*
Tobacco Use Disorder / epidemiology*
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding