Alan Gor 18 March 2025
A Critical Oversight in Public Health
Tobacco control and nicotine research have historically focused on younger demographics, often sidelining the experiences and needs of older adults. This oversight has serious implications for harm reduction strategies, smoking cessation programmes, and public health policies. Given that many older smokers have been using tobacco for decades, ignoring their needs in research and policy discussions represents a missed opportunity to address smoking-related diseases effectively.
The Aging Smoker: A Forgotten Demographic
The dominant narrative in tobacco control often frames smoking as a youth issue, prioritising prevention among adolescents and young adults. While this is undeniably important, it has led to a lack of attention to older smokers, who may have different motivations, barriers, and responses to quitting. Many have unsuccessfully attempted to stop using conventional methods and could benefit significantly from harm-reduction approaches such as vaping or alternative nicotine products.
Historical Bias in Tobacco Control
Public health campaigns have historically focused on youth smoking prevention, which has influenced research funding and policy decisions. Since the 1960s, anti-smoking efforts have aimed to prevent new generations from picking up the habit, leading to significant declines in smoking rates among younger populations. However, this youth-centric approach has inadvertently resulted in the neglect of older smokers who have already developed long-term nicotine dependence.
Unique Challenges Faced by Older Smokers
1. Health Concerns and Comorbidities
Older adults are more likely to suffer from chronic illnesses such as COPD, cardiovascular disease, and diabetes conditions exacerbated by smoking. Quitting or switching to lower-risk alternatives could drastically improve their quality of life, yet research on effective interventions for this group remains scarce. Studies show that even those who have smoked for decades can still experience significant health benefits by switching to smoke-free alternatives, but there remains a lack of targeted studies exploring these outcomes.
2. Psychosocial Factors
Many aging smokers started in an era where smoking was deeply embedded in social and cultural norms. For them, nicotine use is often tied to stress relief, routine, and identity. Unlike younger individuals, they may not be motivated by the same social pressures to quit, requiring tailored strategies. Furthermore, smoking is often associated with coping mechanisms for loneliness, bereavement, and depression, common issues among older adults. Research into the psychological barriers to quitting or switching is essential but largely absent from tobacco control discourse.
3. Mental Health and Smoking
Mental health is a significant but often overlooked factor in smoking and nicotine use among older adults. Many long-term smokers have used nicotine to manage anxiety, depression, PTSD, and other mental health conditions. I, for one, use nicotine to manage my anxiety and PTSD. The abrupt cessation of nicotine, without suitable harm reduction alternatives, can worsen these conditions, making it harder to quit successfully.
Older adults also face increased risks of social isolation, bereavement, and cognitive decline, all of which can contribute to mental health struggles. For some, smoking or nicotine use may serve as a coping mechanism, providing moments of relief or structure to their day. Despite this, mental health considerations are rarely factored into smoking cessation programmes or harm reduction policies.
A more compassionate and inclusive approach to smoking cessation should acknowledge the role of nicotine in managing mental health symptoms, ensuring that alternative solutions such as vaping or nicotine pouches are available and promoted as part of a harm reduction strategy rather than a total abstinence model.
4. Limited Research on Harm Reduction for Older Adults
Studies on vaping and nicotine replacement therapies frequently focus on younger populations, overlooking how older smokers interact with these products. Questions around appropriate nicotine strengths, device preferences, and potential cognitive benefits of nicotine in aging populations remain under-explored. There is also limited discussion on whether nicotine could play a role in neuroprotection, particularly in conditions like Parkinson’s and Alzheimer’s disease, where preliminary research has suggested possible benefits.
5. Stigma and Misinformation
Older adults may also be more susceptible to misinformation about nicotine and vaping due to decades of anti-smoking rhetoric that conflates nicotine with tobacco-related harm. Many believe that nicotine itself is the primary cause of smoking-related diseases, rather than combustion. This misinformation discourages them from considering harm reduction alternatives, despite evidence showing that nicotine, in the absence of smoke, carries minimal health risks.
Why This Matters for Tobacco Harm Reduction
Dismissing older adults in nicotine research contributes to a public health paradox: the very people who stand to benefit most from harm reduction tools are often the least considered. Many aging smokers are already resistant to traditional cessation methods, and failing to offer them viable alternatives increases their risk of tobacco-related diseases.
Research suggests that older adults who switch to vaping or other nicotine alternatives experience significant health improvements, including better lung function, reduced cardiovascular risk, and an improved sense of well-being. However, due to misinformation and stigma, many remain unaware of these options or are deterred by misleading narratives that equate vaping with smoking.
The Role of Policy and Public Health Messaging
Reframing Nicotine Use: Public health organisations should clarify that nicotine itself is not the primary cause of smoking-related diseases. Clear communication can help older smokers make informed decisions.
Targeted Cessation Support: Traditional quit-smoking campaigns often focus on complete abstinence, failing to recognise that harm reduction may be a more realistic and effective approach for older smokers.
Training Healthcare Providers: Many doctors and healthcare professionals remain uninformed about harm reduction, leading to missed opportunities to educate older patients about smoke-free alternatives.
Moving Forward: A Call for Inclusion
1. Prioritise Older Adults in Research
Future studies should actively include older smokers and former smokers who use harm-reduction products, ensuring that policies are evidence-based and inclusive. Research funding should be directed towards understanding how nicotine alternatives impact older populations, particularly in terms of long-term health outcomes and quality of life.
2. Develop Age-Specific Cessation and Harm Reduction Strategies
One-size-fits-all approaches do not work. Public health initiatives must acknowledge the distinct needs of older adults, providing accessible, non-judgmental support. This includes considering factors such as physical dexterity (for using vaping devices), affordability, and technological literacy.
3. Combat Misinformation About Nicotine
The demonisation of nicotine discourages smokers—particularly older ones—from considering harm reduction. Clear, factual messaging that differentiates smoking from nicotine use is crucial. Public health campaigns should work to correct misconceptions and promote evidence-based harm reduction approaches.
4. Address Social and Psychological Barriers
Understanding the role of smoking in the lives of older adults is essential to designing effective interventions. Research should explore the emotional and social aspects of nicotine use, particularly concerning mental health and cognitive well-being.
The underrepresentation of aging adults in nicotine and tobacco research is a critical gap that needs urgent attention. Public health policies must be inclusive of all age groups, recognising that effective harm reduction strategies can significantly improve the lives of long-term smokers. Ignoring this demographic does a disservice to those who have struggled with nicotine addiction for decades, denying them access to safer alternatives and, ultimately, a better quality of life.
By shifting research priorities, combating misinformation, and embracing harm reduction, we can ensure that aging smokers are no longer overlooked in the conversation about tobacco control and public health.