Nicotine - Older Adults (50+): Difference between revisions

(15 intermediate revisions by the same user not shown)

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=Misperceptions=

='''Misperceptions'''=

===2023: [https://tobaccocontrol.bmj.com/content/33/e2/e266.long Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke]===

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***Acknowledgement: This study was funded by the Health Research Council of New Zealand (grant 06/453).

=Smoking and Smoking Cessation=

='''Smoking and Smoking Cessation'''=

*See Also: Smokeless Products

Line 23:

**Citation: Adrienne L Johnson, Jaqueline C Avila, Leslie Christensen, Margaret C Fahey, Jeein Jang, Sarah Jarvis, Alana Rojewski, Dana Rubenstein, Bethea A Kleykamp, Society for Research on Nicotine and Tobacco (SRNT) Treatment Research Network, Smoking Cessation Treatment Efficacy and Impact on Health Outcomes among Middle-Aged and Older Adults: A Scoping Review, Nicotine & Tobacco Research, 2025;, ntaf122, https://doi.org/10.1093/ntr/ntaf122

***Acknowledgement: Abstract accessed June 18, 2025. The editor of this SNW page does not have access to the full paper and could not view who any possible funders are.

===2025: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntaf029/7990603 Lost in the Smoke: Underrepresentation of Aging Adults in Nicotine and Tobacco Research]===

*For some older adults, such as those living below the federal poverty line, smoking prevalence has increased from 13% to 16% between 2011 and 2022. At the same time, older adults are the fastest-growing demographic worldwide, and for the first time in history, their numbers are predicted to exceed those of young people.

**Citation: Kleykamp BA, Smith H, Dewan M, Kalinowski LM, Parsky J, Kulak JA. Lost in the Smoke: Underrepresentation of Aging Adults in Nicotine and Tobacco Research. Nicotine Tob Res. 2025 Jan 30:ntaf029. doi: 10.1093/ntr/ntaf029. Epub ahead of print. PMID: 39883072.

===2025: [https://www.ingentaconnect.com/contentone/png/ajhb/2025/00000049/00000001/art00009 E-cigarettes and Older Adults who Smoke: A Missed Opportunity to Further Reduce Harm?]===

*Manufacturers should consider the barriers to e-cigarette use by older adults who are smoking and design products that are appealing to older smokers. Reducing smoking prevalence in this group is a public health priority.

===2025: [https://www.edwardanselmmd.com/help-for-seniors Help for Seniors]===

*"Several recent government publications including the 2024 Surgeon General’s Report should make us ask if the Department of Health and Human Services and the Centers for Disease Control understand the impact of smoking on health and health care costs for seniors?"

**Source: Website of Edward Anselm, MD, Public Health Advocate

===2024: [https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03728-x Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014–2024]===

*This study aimed to characterise patterns of tobacco smoking and vaping among older adults (≥ 65 years) in England, to explore harm perceptions of e-cigarettes among those who smoke, and to estimate the real-world effectiveness of e-cigarettes for helping older adults to stop smoking.

*Tobacco smoking prevalence remained relatively unchanged over time among older adults

*Older adults were consistently less likely than younger/middle-aged adults to use e-cigarettes to support attempts to quit smoking

*Older smokers reported greater uncertainty about the harms of e-cigarettes compared with cigarettes

*E-cigarettes appeared to be effective for helping older adults to stop smoking (ORadj = 1.50 [0.96–2.34]); whether effectiveness was lower than for younger/middle-aged adults was inconclusive.

**Citation: Jackson SE, Brown J, Shahab L, Cox S. Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014-2024. BMC Med. 2024 Oct 31;22(1):500. doi: 10.1186/s12916-024-03728-x. PMID: 39482655; PMCID: PMC11526569.

***Acknowledgement: Cancer Research UK (PRCRPG-Nov21\100002) funded the Smoking Toolkit Study data collection and salary for SJ and SC. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

===2024: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01056-0 Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults]===

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**Citation: Meza R, Cao P, Jeon J, Warner KE, Levy DT. Trends in US Adult Smoking Prevalence, 2011 to 2022. JAMA Health Forum. 2023 Dec 1;4(12):e234213. doi: 10.1001/jamahealthforum.2023.4213. PMID: 38038988; PMCID: PMC10692849.

***Acknowledgement: This research was supported by grant U54CA229974 from the NCI and FDA Center for Tobacco Products (all authors) and grant U01CA253858 from the NCI (Drs Meza, Cao, Jeon, and Levy).

===2023: [https://pmc.ncbi.nlm.nih.gov/articles/PMC10257741/ The Impact of Older Age on Smoking Cessation Outcomes After Standard Advice to Quit]===

*Logistic regressions assessed interactions of age (<60 vs. ≥ 60 years) by predictors in relation to quit attempts and six-month cessation controlling for treatment.

*Conclusion: Well-known predictors of quit success were differentially associated with quitting in older age (≥60 years) after receiving standard cessation care in primary care. Although older adults in this sample were less nicotine dependent than those younger overall, older adults with high nicotine dependence were less likely to make a quit attempt or successfully quit compared to their younger counterparts. Nicotine dependence could be an important consideration in cessation treatment with older populations; such that older adults with higher dependence might need more intensive treatment including proactive approaches to ensure ease of access to nicotine replacement therapy or other cessation pharmacotherapy. Following standard cessation advice, older adults attempted to quit and succeeded at a similar rate as those younger. Further, older adults unmotivated to quit were more likely to quit compared to unmotivated younger adults.

**Citation: Fahey MC, Dahne J, Wahlquist AE, Carpenter MJ. The Impact of Older Age on Smoking Cessation Outcomes After Standard Advice to Quit. J Appl Gerontol. 2023 Jul;42(7):1477-1485. doi: 10.1177/07334648231158228. Epub 2023 Feb 16. PMID: 36797652; PMCID: PMC10257741.

***Acknowledgement: Funding for this research was provided by National Institute on Drug Abuse (R01 DA021619), (K23 DA045766), (T32 DA007288). Clinical Trials registration number NCT02096029.

===2021: [https://tobaccocontrol.bmj.com/content/early/2021/08/12/tobaccocontrol-2021-056945 Ignoring our elders: tobacco control’s forgotten health equity issue]===

*Those who suffer multiple forms of stigmatisation and feel devalued in society find it harder than higher status, socially valued individuals to change health behaviours, lacking resources and social encouragement to do so. The deprioritisation of older smokers is a symptom of institutionalised ageism, which must be addressed systematically to apply the tenets of health equity and inclusion in our work. Across all areas of tobacco control, we must do better by our elders.

**Citation: McAfee T, Malone RE, Cataldo J, Ignoring our elders: tobacco control’s forgotten health equity issue. Tobacco Control 2021;30:479-480.

===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC9122748/ Age-Related Interactions on Key Theoretical Determinants of Smoking Cessation: Findings from the ITC Four Country Smoking and Vaping Surveys (2016–2020)]===

*Younger smokers were more likely to be abstinent for 6 months if they had reported more immediate plans to quit, while older smokers were less likely to be successful if they indicated short-term plans to quit. The age-stratified analysis for smoking abstinence (Table 3) showed that lower HSI [Heaviness of Smoking Index] predicted smoking abstinence in those under 40 but not in those 40 or older. Lower degrees of wanting to quit and to a lesser extent, planning to quit were also associated with abstinence in the older age group with reverse trends, albeit nonsignificant, for younger smokers. Quit efficacy was associated with success in the older age group only. Most associations remained consistent for 6-month smoking abstinence.

**Citation: Le Grande M, Borland R, Yong HH, McNeill A, Fong G, Cummings KM. Age-Related Interactions on Key Theoretical Determinants of Smoking Cessation: Findings from the ITC Four Country Smoking and Vaping Surveys (2016-2020). Nicotine Tob Res. 2022 Mar 26;24(5):679-689. doi: 10.1093/ntr/ntab230. PMID: 34755869; PMCID: PMC9122748.

***Acknowledgement: The ITC Four Country Smoking and Vaping Project in Australia, Canada, US, and England was supported by the National Health and Medical Research Council of Australia (APP1106451), US National Cancer Institute (P01CA200512), and Canadian Institutes of Health Research (FDN-148477). GTF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. GTF has served as an expert witness on behalf of governments in litigation involving the tobacco industry. KMC has been a consultant and received grant funding from the Pfizer Inc. in the past 5 years. K.M.C has also been a paid expert witness in litigation against the tobacco industry. All other authors have no conflicts of interest to declare.

===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC7885790/ Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking]===

*Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps < .05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up.

**Citation: Pearson JL, Zhou Y, Smiley SL, Rubin LF, Harvey E, Koch B, Niaura R, Abrams DB. Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking. Nicotine Tob Res. 2021 Feb 16;23(3):527-534. doi: 10.1093/ntr/ntaa086. Erratum in: Nicotine Tob Res. 2024 Dec 23;27(1):163. doi: 10.1093/ntr/ntae234. PMID: 32421191; PMCID: PMC7885790.

***Acknowledgement: The research reported in this publication was supported by the National Institute on Drug Abuse (grant number 1R21DA036472) of the National Institutes of Health under grant number 5R21DA036472. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. [https://pmc.ncbi.nlm.nih.gov/articles/PMC7885790/#s0106 Disclosures]

===2020: [https://www.sciencedirect.com/science/article/pii/S0085253815469595 Tobacco, hypertension, and vascular disease: Risk factors for renal functional decline in an older population]===

*The finding of an association between current cigarette use and an increase in serum creatinine suggests that even in older individuals, smoking cessation is of significant importance in preserving health.

**Citation: Bleyer AJ, Shemanski LR, Burke GL, Hansen KJ, Appel RG. Tobacco, hypertension, and vascular disease: risk factors for renal functional decline in an older population. Kidney Int. 2000 May;57(5):2072-9. doi: 10.1046/j.1523-1755.2000.00056.x. PMID: 10792626.

***Acknowledgement: This study was supported by Contract N01-HC-85079-85086 from the National Heart, Lung, and Blood Institute (Bethesda, MD, USA).

===2019: Article: [https://filtermag.org/older-smokers-vaping/amp/ Older Smokers Are the Forgotten Victims of Our Vaping Wars]===

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**Source: Annie Kleykamp, ''Filter Magazine''

===2018: ~~Power Point~~: [https://~~archive~~.~~gfn~~.~~events~~/~~downloads/2018/AnnieKleykamp.pdf~~ Rethinking nicotine across the lifespan: What about the older smoker?]===

===2018: Video: [https://www.youtube.com/watch?v=NGzw5ndFnIw Rethinking nicotine across the lifespan: What about the older smoker?]===

*GFN: Annie Kleykamp, PhD

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**Citation: Kleykamp, B. A., & Heishman, S. J. (2011). The Older Smoker. JAMA, 306(8). doi:10.1001/jama.2011.1221

=Smokeless Products=

='''Smokeless Products'''=

*See also: Smoking and Smoking Cessation

===ENDS (NVP, E-Cigarettes, E-Cigs, Vapes)===

==='''ENDS (NVP, E-Cigarettes, E-Cigs, Vapes)'''===

====2023: [https://www.phcc.org.nz/briefing/vaping-prevalence-and-trends-key-findings-2022-23-nz-health-survey Vaping prevalence and trends: key findings in the 2022-23 NZ Health Survey]====

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***Acknowledgement: This research was supported in part by funding from the National Institutes of Health (R01CA19044 [CDD and MBS] and K01DA037950 [JLP]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

===Snus===

==='''Snus'''===

====2021: [https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01979-6 Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals]====

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***Acknowledgements: Work of the authors is supported by grants from the Geriatric Foundation, research for healthy aging, and Börjeson, Emil and Ragna Foundation (to O.E.T.), the Swedish Research Council for Health, Working Life and Welfare (Forte; grant number 2018-00123) (to S.C.L.), the Swedish Research Council (Vetenskapsrådet; grant number 2016-01042 and 2019-00977) (to S.C.L.), and the Swedish Heart-Lung Foundation (Hjärt-Lungfonden; grant number 20190247) (to S.C.L.). The study was also supported by additional grants from the Swedish Research Council (https://www.vr.se; grant no 2015-03257, 2017-00644 and 2017-06100 to KM). SIMPLER receives funding through the Swedish Research Council under the grant no 2017-00644 (to Uppsala University and KM). SNIC is financially supported by the Swedish Research Council. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Open Access funding provided by Uppsala University.

=Therapeutic Benefits=

='''Therapeutic Benefits'''=

===Auditory===

==='''Auditory'''===

====2021 [https://www.nature.com/articles/s41598-021-92588-z Task-dependent effects of nicotine treatment on auditory performance in young-adult and elderly human nonsmokers]====

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**Citation: Sun, S., Kapolowicz, M.R., Richardson, M. et al. Task-dependent effects of nicotine treatment on auditory performance in young-adult and elderly human nonsmokers. Sci Rep 11, 13187 (2021). doi: 10.1038/s41598-021-92588-z

===Memory and Cognitive Ability===

==='''Memory and Cognitive Ability'''===

====[https://mindstudy.org/ MIND (Memory Improvement through Nicotine Dosing) Study]====

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**Citation: Levin ED, Rezvani AH. Nicotinic treatment for cognitive dysfunction. Curr Drug Targets CNS Neurol Disord. 2002 Aug;1(4):423-31. doi: 10.2174/1568007023339102. PMID: 12769614.

===Mental Health===

==='''Mental and Behavorial Health'''===

====2020 [https://www.sciencedirect.com/science/article/abs/pii/S0028390819305003?via%3Dihub Regulation of aggressive behaviors by nicotinic acetylcholine receptors: Animal models, human genetics, and clinical studies]====

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***Acknowledgement: Supported by NIH grants K24 MH110598 and CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences.

=Very Low Nicotine Content Cigarettes=

='''Very Low Nicotine Content Cigarettes'''=

===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC8372658/ Responses to Gradual and Immediate Reduction of Nicotine in Cigarettes in Young Versus Older Adult Smokers]===

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***Acknowledgements: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. Research supported by a grant from the National Institute on Drug Abuse and the Food and Drug Administration Center for Tobacco Products (U54DA031659; Donny/Hatsukami). Manuscript preparation supported by NCI K01CA189300 (PI Cassidy), K01DA047433 (Smith), and NIDA P50DA036114.

=See Also=

='''See Also'''=

===[https://www.youtube.com/@goldenoldiescapitoltours6536 Golden Oldies Capitol Tours]===

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===[https://safernicotine.wiki/mediawiki/index.php/Old_farts_vaping Old Farts Vaping]===

=Suggestions to add to this page=

='''Suggestions to add to this page'''=

@@ Line 3: / Line 3: @@
-=Misperceptions=
+='''Misperceptions'''=
 ===2023: [https://tobaccocontrol.bmj.com/content/33/e2/e266.long Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke]===
@@ Line 16: / Line 16: @@
 ***Acknowledgement: This study was funded by the Health Research Council of New Zealand (grant 06/453).
-=Smoking and Smoking Cessation=
+='''Smoking and Smoking Cessation'''=
 *See Also: Smokeless Products
@@ Line 23: / Line 23: @@
 **Citation: Adrienne L Johnson, Jaqueline C Avila, Leslie Christensen, Margaret C Fahey, Jeein Jang, Sarah Jarvis, Alana Rojewski, Dana Rubenstein, Bethea A Kleykamp, Society for Research on Nicotine and Tobacco (SRNT) Treatment Research Network, Smoking Cessation Treatment Efficacy and Impact on Health Outcomes among Middle-Aged and Older Adults: A Scoping Review, Nicotine & Tobacco Research, 2025;, ntaf122, https://doi.org/10.1093/ntr/ntaf122
 ***Acknowledgement: Abstract accessed June 18, 2025. The editor of this SNW page does not have access to the full paper and could not view who any possible funders are.
+===2025: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntaf029/7990603 Lost in the Smoke: Underrepresentation of Aging Adults in Nicotine and Tobacco Research]===
+*For some older adults, such as those living below the federal poverty line, smoking prevalence has increased from 13% to 16% between 2011 and 2022. At the same time, older adults are the fastest-growing demographic worldwide, and for the first time in history, their numbers are predicted to exceed those of young people.
+**Citation: Kleykamp BA, Smith H, Dewan M, Kalinowski LM, Parsky J, Kulak JA. Lost in the Smoke: Underrepresentation of Aging Adults in Nicotine and Tobacco Research. Nicotine Tob Res. 2025 Jan 30:ntaf029. doi: 10.1093/ntr/ntaf029. Epub ahead of print. PMID: 39883072.
+===2025: [https://www.ingentaconnect.com/contentone/png/ajhb/2025/00000049/00000001/art00009 E-cigarettes and Older Adults who Smoke: A Missed Opportunity to Further Reduce Harm?]===
+*Manufacturers should consider the barriers to e-cigarette use by older adults who are smoking and design products that are appealing to older smokers. Reducing smoking prevalence in this group is a public health priority.
+===2025: [https://www.edwardanselmmd.com/help-for-seniors Help for Seniors]===
+*"Several recent government publications including the 2024 Surgeon General’s Report should make us ask if the Department of Health and Human Services and the Centers for Disease Control understand the impact of smoking on health and health care costs for seniors?"
+**Source: Website of Edward Anselm, MD, Public Health Advocate
+===2024: [https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03728-x Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014–2024]===
+*This study aimed to characterise patterns of tobacco smoking and vaping among older adults (≥ 65 years) in England, to explore harm perceptions of e-cigarettes among those who smoke, and to estimate the real-world effectiveness of e-cigarettes for helping older adults to stop smoking.
+*Tobacco smoking prevalence remained relatively unchanged over time among older adults
+*Older adults were consistently less likely than younger/middle-aged adults to use e-cigarettes to support attempts to quit smoking
+*Older smokers reported greater uncertainty about the harms of e-cigarettes compared with cigarettes
+*E-cigarettes appeared to be effective for helping older adults to stop smoking (ORadj = 1.50 [0.96–2.34]); whether effectiveness was lower than for younger/middle-aged adults was inconclusive.
+**Citation: Jackson SE, Brown J, Shahab L, Cox S. Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014-2024. BMC Med. 2024 Oct 31;22(1):500. doi: 10.1186/s12916-024-03728-x. PMID: 39482655; PMCID: PMC11526569.
+***Acknowledgement: Cancer Research UK (PRCRPG-Nov21\100002) funded the Smoking Toolkit Study data collection and salary for SJ and SC. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
 ===2024: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01056-0 Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults]===
@@ Line 38: / Line 58: @@
 **Citation: Meza R, Cao P, Jeon J, Warner KE, Levy DT. Trends in US Adult Smoking Prevalence, 2011 to 2022. JAMA Health Forum. 2023 Dec 1;4(12):e234213. doi: 10.1001/jamahealthforum.2023.4213. PMID: 38038988; PMCID: PMC10692849.
 ***Acknowledgement: This research was supported by grant U54CA229974 from the NCI and FDA Center for Tobacco Products (all authors) and grant U01CA253858 from the NCI (Drs Meza, Cao, Jeon, and Levy).
+===2023: [https://pmc.ncbi.nlm.nih.gov/articles/PMC10257741/ The Impact of Older Age on Smoking Cessation Outcomes After Standard Advice to Quit]===
+*Logistic regressions assessed interactions of age (<60 vs. ≥ 60 years) by predictors in relation to quit attempts and six-month cessation controlling for treatment.
+*Conclusion: Well-known predictors of quit success were differentially associated with quitting in older age (≥60 years) after receiving standard cessation care in primary care. Although older adults in this sample were less nicotine dependent than those younger overall, older adults with high nicotine dependence were less likely to make a quit attempt or successfully quit compared to their younger counterparts. Nicotine dependence could be an important consideration in cessation treatment with older populations; such that older adults with higher dependence might need more intensive treatment including proactive approaches to ensure ease of access to nicotine replacement therapy or other cessation pharmacotherapy. Following standard cessation advice, older adults attempted to quit and succeeded at a similar rate as those younger. Further, older adults unmotivated to quit were more likely to quit compared to unmotivated younger adults.
+**Citation: Fahey MC, Dahne J, Wahlquist AE, Carpenter MJ. The Impact of Older Age on Smoking Cessation Outcomes After Standard Advice to Quit. J Appl Gerontol. 2023 Jul;42(7):1477-1485. doi: 10.1177/07334648231158228. Epub 2023 Feb 16. PMID: 36797652; PMCID: PMC10257741.
+***Acknowledgement: Funding for this research was provided by National Institute on Drug Abuse (R01 DA021619), (K23 DA045766), (T32 DA007288). Clinical Trials registration number NCT02096029.
 ===2021: [https://tobaccocontrol.bmj.com/content/early/2021/08/12/tobaccocontrol-2021-056945 Ignoring our elders: tobacco control’s forgotten health equity issue]===
 *Those who suffer multiple forms of stigmatisation and feel devalued in society find it harder than higher status, socially valued individuals to change health behaviours, lacking resources and social encouragement to do so. The deprioritisation of older smokers is a symptom of institutionalised ageism, which must be addressed systematically to apply the tenets of health equity and inclusion in our work. Across all areas of tobacco control, we must do better by our elders.
 **Citation: McAfee T, Malone RE, Cataldo J, Ignoring our elders: tobacco control’s forgotten health equity issue. Tobacco Control 2021;30:479-480.
+===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC9122748/ Age-Related Interactions on Key Theoretical Determinants of Smoking Cessation: Findings from the ITC Four Country Smoking and Vaping Surveys (2016–2020)]===
+*Younger smokers were more likely to be abstinent for 6 months if they had reported more immediate plans to quit, while older smokers were less likely to be successful if they indicated short-term plans to quit. The age-stratified analysis for smoking abstinence (Table 3) showed that lower HSI [Heaviness of Smoking Index] predicted smoking abstinence in those under 40 but not in those 40 or older. Lower degrees of wanting to quit and to a lesser extent, planning to quit were also associated with abstinence in the older age group with reverse trends, albeit nonsignificant, for younger smokers. Quit efficacy was associated with success in the older age group only. Most associations remained consistent for 6-month smoking abstinence.
+**Citation: Le Grande M, Borland R, Yong HH, McNeill A, Fong G, Cummings KM. Age-Related Interactions on Key Theoretical Determinants of Smoking Cessation: Findings from the ITC Four Country Smoking and Vaping Surveys (2016-2020). Nicotine Tob Res. 2022 Mar 26;24(5):679-689. doi: 10.1093/ntr/ntab230. PMID: 34755869; PMCID: PMC9122748.
+***Acknowledgement: The ITC Four Country Smoking and Vaping Project in Australia, Canada, US, and England was supported by the National Health and Medical Research Council of Australia (APP1106451), US National Cancer Institute (P01CA200512), and Canadian Institutes of Health Research (FDN-148477). GTF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. GTF has served as an expert witness on behalf of governments in litigation involving the tobacco industry. KMC has been a consultant and received grant funding from the Pfizer Inc. in the past 5 years. K.M.C has also been a paid expert witness in litigation against the tobacco industry. All other authors have no conflicts of interest to declare.
+===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC7885790/ Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking]===
+*Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps < .05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up.
+**Citation: Pearson JL, Zhou Y, Smiley SL, Rubin LF, Harvey E, Koch B, Niaura R, Abrams DB. Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking. Nicotine Tob Res. 2021 Feb 16;23(3):527-534. doi: 10.1093/ntr/ntaa086. Erratum in: Nicotine Tob Res. 2024 Dec 23;27(1):163. doi: 10.1093/ntr/ntae234. PMID: 32421191; PMCID: PMC7885790.
+***Acknowledgement: The research reported in this publication was supported by the National Institute on Drug Abuse (grant number 1R21DA036472) of the National Institutes of Health under grant number 5R21DA036472. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. [https://pmc.ncbi.nlm.nih.gov/articles/PMC7885790/#s0106 Disclosures]
+===2020: [https://www.sciencedirect.com/science/article/pii/S0085253815469595 Tobacco, hypertension, and vascular disease: Risk factors for renal functional decline in an older population]===
+*The finding of an association between current cigarette use and an increase in serum creatinine suggests that even in older individuals, smoking cessation is of significant importance in preserving health.
+**Citation: Bleyer AJ, Shemanski LR, Burke GL, Hansen KJ, Appel RG. Tobacco, hypertension, and vascular disease: risk factors for renal functional decline in an older population. Kidney Int. 2000 May;57(5):2072-9. doi: 10.1046/j.1523-1755.2000.00056.x. PMID: 10792626.
+***Acknowledgement: This study was supported by Contract N01-HC-85079-85086 from the National Heart, Lung, and Blood Institute (Bethesda, MD, USA).
 ===2019: Article: [https://filtermag.org/older-smokers-vaping/amp/ Older Smokers Are the Forgotten Victims of Our Vaping Wars]===
@@ Line 47: / Line 88: @@
 **Source: Annie Kleykamp, ''Filter Magazine''
-===2018: Power Point: [https://archive.gfn.events/downloads/2018/AnnieKleykamp.pdf Rethinking nicotine across the lifespan:  What about the older smoker?]===
+===2018: Video: [https://www.youtube.com/watch?v=NGzw5ndFnIw Rethinking nicotine across the lifespan:  What about the older smoker?]===
 *GFN: Annie Kleykamp, PhD
@@ Line 64: / Line 105: @@
 **Citation: Kleykamp, B. A., & Heishman, S. J. (2011). The Older Smoker. JAMA, 306(8). doi:10.1001/jama.2011.1221
-=Smokeless Products=
+='''Smokeless Products'''=
 *See also: Smoking and Smoking Cessation
-===ENDS (NVP, E-Cigarettes, E-Cigs, Vapes)===
+==='''ENDS (NVP, E-Cigarettes, E-Cigs, Vapes)'''===
 ====2023: [https://www.phcc.org.nz/briefing/vaping-prevalence-and-trends-key-findings-2022-23-nz-health-survey Vaping prevalence and trends: key findings in the 2022-23 NZ Health Survey]====
@@ Line 82: / Line 123: @@
 ***Acknowledgement: This research was supported in part by funding from the National Institutes of Health (R01CA19044 [CDD and MBS] and K01DA037950 [JLP]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.
-===Snus===
+==='''Snus'''===
 ====2021: [https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01979-6 Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals]====
@@ Line 89: / Line 130: @@
 ***Acknowledgements: Work of the authors is supported by grants from the Geriatric Foundation, research for healthy aging, and Börjeson, Emil and Ragna Foundation (to O.E.T.), the Swedish Research Council for Health, Working Life and Welfare (Forte; grant number 2018-00123) (to S.C.L.), the Swedish Research Council (Vetenskapsrådet; grant number 2016-01042 and 2019-00977) (to S.C.L.), and the Swedish Heart-Lung Foundation (Hjärt-Lungfonden; grant number 20190247) (to S.C.L.). The study was also supported by additional grants from the Swedish Research Council (https://www.vr.se; grant no 2015-03257, 2017-00644 and 2017-06100 to KM). SIMPLER receives funding through the Swedish Research Council under the grant no 2017-00644 (to Uppsala University and KM). SNIC is financially supported by the Swedish Research Council. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Open Access funding provided by Uppsala University.
-=Therapeutic Benefits=
+='''Therapeutic Benefits'''=
-===Auditory===
+==='''Auditory'''===
 ====2021 [https://www.nature.com/articles/s41598-021-92588-z Task-dependent effects of nicotine treatment on auditory performance in young-adult and elderly human nonsmokers]====
@@ Line 98: / Line 139: @@
 **Citation: Sun, S., Kapolowicz, M.R., Richardson, M. et al. Task-dependent effects of nicotine treatment on auditory performance in young-adult and elderly human nonsmokers. Sci Rep 11, 13187 (2021). doi: 10.1038/s41598-021-92588-z
-===Memory and Cognitive Ability===
+==='''Memory and Cognitive Ability'''===
 ====[https://mindstudy.org/ MIND (Memory Improvement through Nicotine Dosing) Study]====
@@ Line 135: / Line 176: @@
 **Citation: Levin ED, Rezvani AH. Nicotinic treatment for cognitive dysfunction. Curr Drug Targets CNS Neurol Disord. 2002 Aug;1(4):423-31. doi: 10.2174/1568007023339102. PMID: 12769614.
-===Mental Health===
+==='''Mental and Behavorial Health'''===
 ====2020 [https://www.sciencedirect.com/science/article/abs/pii/S0028390819305003?via%3Dihub Regulation of aggressive behaviors by nicotinic acetylcholine receptors: Animal models, human genetics, and clinical studies]====
@@ Line 155: / Line 196: @@
 ***Acknowledgement: Supported by NIH grants K24 MH110598 and CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences.
-=Very Low Nicotine Content Cigarettes=
+='''Very Low Nicotine Content Cigarettes'''=
 ===2021: [https://pmc.ncbi.nlm.nih.gov/articles/PMC8372658/ Responses to Gradual and Immediate Reduction of Nicotine in Cigarettes in Young Versus Older Adult Smokers]===
@@ Line 163: / Line 204: @@
 ***Acknowledgements: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. Research supported by a grant from the National Institute on Drug Abuse and the Food and Drug Administration Center for Tobacco Products (U54DA031659; Donny/Hatsukami). Manuscript preparation supported by NCI K01CA189300 (PI Cassidy), K01DA047433 (Smith), and NIDA P50DA036114.
-=See Also=
+='''See Also'''=
 ===[https://www.youtube.com/@goldenoldiescapitoltours6536 Golden Oldies Capitol Tours]===
@@ Line 169: / Line 210: @@
 ===[https://safernicotine.wiki/mediawiki/index.php/Old_farts_vaping Old Farts Vaping]===
-=Suggestions to add to this page=
+='''Suggestions to add to this page'''=