Older Adults Who Smoke Are Typically “Forgotten”

November 29, 2022

A new paper, published in the American Journal of Public Health (AJPH), argues that older adults who smoke are “forgotten,” and that more needs to be done to address “the incredible burden of disease and death that this population carries.”

“The number of adults aged 65 years and older is expected to more than double worldwide over the next several decades, and for the first time in record history, older adults will outnumber children,” write the authors, Annie Kleykamp of BAK and Associates and Jessica Kulak of the University of Buffalo. “Despite these unprecedented population shifts, older adults are significantly underrepresented in biomedical research, especially in the field of nicotine and tobacco science. This focus on younger cohorts has obscured the reality that combustible tobacco use (i.e. smoking) has remained virtually unchanged for older adults for nearly two decades in the United States.”

In their AJPH article, the authors note that traditional tobacco control policies such as information campaigns and advertising bans are not as effective among older people who smoke. They write that this population is less likely to understand the relative harms of nicotine and combustible tobacco use, to use safer nicotine alternatives, to consult the internet for information, or even to know where to locate local cessation services. They also acknowledge that older people who smoke “face a range of socially and medically complex challenges,” like the fact that they are disproportionately likely to be Indigenous, Black or multiracial; to have less than a high school education; and to have annual income below $25,000.

“Although efforts to prevent uptake among young people are critical, they should not supersede a focus on the lives of older smokers.”

Kleykamp and Kulak highlight, too, how tobacco harm reduction interventions—encouraging people who currently smoke to switch to safer options, like vapes—are rarely discussed for this population, and funding options are “rarely tailored to older adults.”

“The topic of tobacco harm reduction has become a lightning rod for disagreement because of ongoing concerns that novel nicotine products such as electronic cigarettes … could damage the health of nonsmokers, including youths,” they write. “Although efforts to prevent the uptake of tobacco and nicotine use among young people are critical, they should not supersede a focus on the lives of older smokers. Prioritizing dependence over harm reduction is not ethically justified.”

Nonetheless, so much of the tobacco control conversation still revolves around preventing underage use of e-cigarettes—despite evidence that policies such as flavor bans often have adverse effects.

This is to say nothing of the fact that few teens smoke combustible cigarettes at all. Recent data from the Centers for Disease Control and Prevention (CDC) found that smoking among youth is, essentially, nonexistent in 2022, while vaping had a modest uptick from 2021. In 2022, for example, the CDC’s National Youth Tobacco Survey showed that 14.1 percent of high school students reported “current e-cigarette use,” which can mean vaping just once in the past 30 days; in 2021, NYTS reported that “current” use for high schoolers was at 11.3 percent. Those numbers are far below what was seen at the height of the so-called vaping “epidemic,” when the CDC said that 20.8 percent of high schoolers were “current” vapers.

“There needs to be an acknowledgment that people do smoke into older ages. They don’t simply disappear or die. They are alive and they need our support.”

“To address this gap, we need research and funding opportunities specifically focused on older adults,” Kleykamp told Filter. She has previously written for Filter about how older people who smoke are typically left out of the vaping conversation.

“Similar to funding initiatives focused on youth, we can have parity with funding for older adults,” she continued. “Researchers also need to be more aware of this gap and control for it in their studies by purposely recruiting people who are above the age of 60 to participate.”

The tide, though, might be changing a little. Matthew Holman, who until this year was the top scientist at the FDA’s Center for Tobacco Products before leaving for a high-profile job at Philip Morris International (PMI), published a recent op-ed arguing that the agency “can do more to help America stop smoking.” While lauding efforts to reduce combustible cigarette use among youth, he stated that this same progress “isn’t being matched by a driving down of the number of adult smokers, currently numbering 34 million Americans according to the American Cancer Society,” and added that the Food and Drug Administration needs “to start talking to smokers again like they did before the 2018 National Youth Tobacco Survey data were released.” That is, before the youth vaping “epidemic” began to dominate headlines and, consequently, much of the mainstream narrative.

Like Holman, Kleykamp emphasized that there has to be a shift in our collective thinking.

“There needs to be an acknowledgment that people do smoke into older ages,” she told Filter. “They don’t simply disappear or die. They are alive and they need our support. And population-level data tell us that many older adults do not want to stop or can’t stop smoking with traditional approaches. This means that any research focused on harm reduction—whether it be reducing cigarettes, education on relative harms, switching to safer products—should be a focus if we really want to reduce suffering.”



Photograph by Dick Vos via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, has received grants from PMI. Filters Editorial Independence Policy applies.

Alex Norcia

Alex was formerly Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in the New York Times Magazine, the Columbia Journalism Review, the Los Angeles Times and the New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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