Nicotine and Tobacco Product Use and Dependence Symptoms Among US Adolescents and Adults: Differences by Age, Sex, and Sexual Identity

Abstract

Introduction: Sexual minorities are at increased risk for tobacco use; however, there is heterogeneity in this risk by sociodemographic factors.

Aims and methods: This study sought to understand if vulnerability to tobacco use among US sexual minorities varies by age group. For this study we used data from wave 4 of the Population Assessment of Tobacco and Health adolescent and adult surveys (n = 37 959), a nationally representative survey. We examined five nicotine/tobacco use outcomes by sex and sexual identity across four age groups. The five outcomes included past 30-day e-cigarette use, past 30-day cigarette use, past 30-day other tobacco use, the number of tobacco products used, and nicotine dependence symptoms.

Results: For males, sexual identity differences were greatest in middle adulthood, particularly for bisexual males; adjusted odds ratios and adjusted incident rate ratios ranged from 2.08 to 5.59 in middle adulthood compared to 0.83-1.62 in adolescence. For females, sexual identity differences were persistent from adolescence through middle adulthood. We found significant differences most consistently for nicotine dependence symptoms when comparing gay/lesbian and bisexual females across multiple age groups; adjusted incident rate ratios ranged from 1.90 in middle adulthood to 3.26 in adolescence.

Conclusions: Risk among sexual minorities varied considerably across age groups and by nicotine/tobacco product and severity of symptoms. Our findings underscore the importance of looking beyond single tobacco products when examining nicotine/tobacco differences related to sexual identity and in examining differences by age group. Our results demonstrating age-varying risk among sexual minorities have important implications for tobacco prevention and cessation efforts.

Implications: This study identifies important age variation in sexual minority differences in tobacco use, particularly among males. This study also shows that many sexual minorities not only have higher risk for tobacco and nicotine product use but also use significantly more tobacco products and have higher nicotine dependence symptom scores. These results have important implications for implementation of nicotine and tobacco prevention and cessation strategies for sexual minority adolescents and adults.

Figure 1.

Number of nicotine/tobacco products by sex and sexual identity across four age groups (n = 37 959). *Significantly different from heterosexual of the same sex and age group at p < .05 after controlling for race, ethnicity, and region.

Figure 2.

Nicotine dependence scale by sex and sexual identity across four age groups (n = 37 959). *Significantly different from heterosexual of the same sex and age group at p < .05 after controlling for race, ethnicity, and region.