Factors Associated with Smoking Among Sexual and Gender Minority Older Adults: The Roles of Loneliness, Depression, Perceived Stress, Discrimination, and Social Support

Background/Purpose: The sexual and gender minority (SGM; i.e., non-heterosexual or non-cisgender) population has higher rates of tobacco use across the lifespan compared to their heterosexual and cisgender counterparts. For example, sexual minority men above the age of 50 are approximately 1.5 times more likely to smoke tobacco than their heterosexual counterparts. Little else is known about tobacco use among SGM older adults. It is important to understand factors that contribute to elevated rates of smoking among SGM older adults since it is one of the leading causes of preventable morbidity and mortality. This study aimed to explore factors pertinent to the lives of SGM older adults that may contribute to their smoking behaviors.

Methods: Data came from the 2010 National Health, Aging and Sexuality/Gender Study (NHAS), the first federally-funded longitudinal national survey designed to better understand the aging, health, and well-being of LGBTQ older adults and their families. The final analytic sample included 2,338 LGBT older adults aged 50 years and older. Smoking was measured by current smoker (yes/no), defined as currently smoking every day or some days. Loneliness was measured with the 3-item loneliness scale, which measures subjective perception of not belonging, isolation, and disconnection. Depression was measured by the 10-item short form from the CES-D scale. Perceived stress was measured using the 4-item Perceived Stress Scale (PSS4), which assesses the degree to which respondents perceived the events and situation in their lives. Social support was assessed by the 4-item abbreviated Social Support Instrument adapted to measure the degree of perceived social support. Logistic regression was conducted to identify factors associated with LGBT older adults’ smoking behavior. Covariates included age, gender, race/ethnicity, marital/partner status, sexual orientation, transgender, employment, income, BMI, health insurance, and chronic conditions,

Results: Findings indicate that SGM older adults who experienced loneliness, depression, and perceived stress were 60%, 4%, and 44% more likely to smoke cigarettes, respectively (OR=1.60, 95% Confidence Interval [CI] = 1.26-2.04, p<.001; OR=1.04, 95% CI=1.02-1.06, p<.001; OR=1.44, 95% CI=1.19-1.74, p<.001). SGM older adults who received social support were 23% less likely to smoke cigarettes (OR=.77, 95% CI=.62-.96, p<.05). Age, education, and marital/partner status were associated with lower likelihood of smoking while employment status were associated with greater likelihood of smoking status. Discrimination was not significantly associated with smoking.

Conclusions and Implications: SGM older adults are at an increased risk of smoking cigarettes if they experience loneliness, depression, or stress, while those with stronger social support are at a lower risk of smoking. Social workers should consider these factors when attempting to reduce smoking among SGM older adults.