BACKGROUND: Tobacco and alcohol co-use among older adults, particularly those from underprivileged backgrounds, poses significant health risks. This study examines factors associated with these behaviors to inform effective interventions. Underprivileged status was defined by income level and healthcare access.
METHODS: This mixed-methods study, conducted from January 2023 to August 2024 as part of the Generations Connect project. Quantitative data from 6704 older adults (mean age 77.83; 73.1% female) were collected via questionnaires assessing demographics, tobacco and alcohol use, primary healthcare engagement, physical activity levels, and eHealth literacy (eHEALS). Quantitative data were analyzed using Chi-square tests, univariate general linear models, and multinomial logistic regression. Qualitative data were gathered through semi-structured interviews and analyzed thematically.
RESULTS: Smoking and drinking prevalence was low: 2.2% smoked only, 6.0% drank only, and 0.9% were co-users. Co-use was more prevalent among younger participants (65-74 years) (=25.008, df=6, p<0.001) and those living in public housing (=29.94, df=3, p<0.001), who had 235% higher odds of co-use (Odds risk (OR)=3.35, p=0.005). Co-users had 54% lower odds of engagement in primary healthcare system (e.g., being DHC members, OR=0.46, p=0.03) and 41% lower odds of achieving 300 minutes-per-week of exercise (OR=0.59, p=0.05). eHEALS scores were significantly lower among co-users (F_{(3, 6404)}=2.67, p=0.046), with the lowest scores observed in this group (15.67±9.52). Qualitative data from 29 participants (aged 65-91, 62.1% female) were gathered through semi-structured interviews and analyzed thematically.
CONCLUSIONS: Co-use of tobacco and alcohol in older adults is associated with poorer health outcomes and lower eHealth literacy. Targeted interventions, including digital health education and enhanced participation in primary care services, are crucial for addressing the vulnerabilities of co-users and reducing associated health risks. Future randomized controlled trials can elucidate causal links between these factors and health behaviors.