Smoking - Age 65+ in United States

United States

Smoking cigarettes is the leading cause of preventable death in the United States. Smoking damages nearly every organ and can cause heart disease, stroke, diabetes, multiple types of cancer, and respiratory conditions such as emphysema and chronic bronchitis. 

Smoking cessation has been shown to improve health outcomes among older adults and long-term smokers. Some advantages include reduced blood pressure, improved lung and heart function, better breathing and decreased risk of heart attack or stroke. 

Smoking costs the U.S. over $600 billion annually in direct health care expenditures and productivity losses due to premature death and secondhand smoke.

According to America’s Health Rankings analysis, the prevalence of smoking is higher among:

• Older men compared with older women.
• American Indian/Alaska Native, multiracial and Black older adults compared with white, Hispanic and Asian older adults. 
• Older adults with less than a high school education compared with those who have higher levels of education; college graduates have the lowest prevalence.
• Older adults with an annual household income less than $25,000 compared with those with higher levels of income; the prevalence of smoking is higher with each decrease in income level. 
• Older adults who have difficulty with self-care, difficulty seeing, independent living difficulty, difficulty with cognition and difficulty with mobility compared with older adults with difficulty hearing and those without a disability.
• Older adults living in nonmetropolitan areas compared with those in metropolitan areas.
• Older lesbian, gay, bisexual and queer (LGBQ+) adults compared with older straight adults.

While the best strategy to reduce the health consequences of smoking is to prevent people from smoking in the first place, there is much to gain through smoking cessation. Quitting smoking at any age can have profound benefits on current health and long-term outcomes. Most of the risks associated with smoking for cardiovascular disease can be overcome within five years of quitting. The risk of heart attack drops sharply one to two years after quitting, and stroke risk falls to about the same level as nonsmokers around five years after quitting. After 10-15 years, the risk of lung cancer drops to half that of current smokers.

Improving Medicaid coverage of smoking cessation programs is a promising avenue due to the high prevalence of smokers enrolled in Medicaid. Various interventions have proven effective, including counseling with a cessation specialist, telephone counseling and texting-based programs. Combining counseling with medication, such as nicotine replacement therapy, can double the chances of quitting.

Evidence-based interventions and additional resources are available from:

• The Centers for Disease Control and Prevention’s online guide to state smoking cessation and tobacco control programs.
• County Health Rankings & Roadmaps’ What Works for Health list of evidence-based strategies to address tobacco use. 
• The National Cancer Institute’s Smokefree.gov website offers free, accurate and evidence-based information along with professional assistance to support the immediate and long-term needs of smokers trying to quit.

Healthy People 2030 has several objectives related to cigarette smoking and smoking cessation, including:

• Reducing current cigarette smoking in adults.
• Increasing past-year attempts to quit smoking in adults. 
• Increasing successful quit attempts in adults who smoke.
• Increasing the proportion of adults who get advice to quit smoking from a health care provider. 
• Increasing the use of smoking cessation counseling and medication in adults who smoke.

DiGiulio, Anne, Zach Jump, Stephen Babb, Anna Schecter, Kisha-Ann S. Williams, Debbie Yembra, and Brian S. Armour. “State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018.” MMWR. Morbidity and Mortality Weekly Report 69, no. 6 (February 14, 2020): 155–60. https://doi.org/10.15585/mmwr.mm6906a2.

Gellert, Carolin, Ben Schöttker, Heiko Müller, Bernd Holleczek, and Hermann Brenner. “Impact of Smoking and Quitting on Cardiovascular Outcomes and Risk Advancement Periods among Older Adults.” European Journal of Epidemiology 28, no. 8 (August 2013): 649–58. https://doi.org/10.1007/s10654-013-9776-0.

Henley, S. Jane, Kat Asman, Behnoosh Momin, M. Shayne Gallaway, MaryBeth B. Culp, Kathleen R. Ragan, Thomas B. Richards, and Stephen Babb. “Smoking Cessation Behaviors among Older U.S. Adults.” Preventive Medicine Reports 16 (December 2019): 100978. https://doi.org/10.1016/j.pmedr.2019.100978.

Shah, Reena S., and John W. Cole. “Smoking and Stroke: The More You Smoke the More You Stroke.” Expert Review of Cardiovascular Therapy 8, no. 7 (July 2010): 917–32. https://doi.org/10.1586/erc.10.56.

U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Publications and Reports of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020.https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf.