Nicotine - Older Adults (50+)

Misperceptions

2023: Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke

• Adults aged ≥55 are more likely to have misperceptions about the absolute and relative risks of tobacco products, which may contribute to continued smoking. Health communications targeting this age group could modify beliefs about the perceived harms of tobacco products.
  • Citation: Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, Carroll DM, McClernon FJ. Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke. Tob Control. 2024 Nov 10;33(e2):e266-e269. doi: 10.1136/tc-2023-057943. PMID: 37137702; PMCID: PMC10622327.
    • Acknowledgement: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (award number TL1 TR002555). This work was also funded by the National Institute on Minority Health and Health Disparities (K01MD014795; DMC).

2010: Smokers commonly misperceive that nicotine is a major carcinogen: National survey data

• These findings are concerning since misperceptions about nicotine may result in underutilisation of NRT. Therefore, we aimed to assess these views in New Zealand (NZ) smokers, with the context being a country in which NRT is provided in a heavily subsidised form and widely distributed via the national quitline service.
• When asked if ‘the nicotine in cigarettes is the chemical that causes most of the cancer?’, most smokers in wave 1 (52.6%) said that it was true, 36.7% said it was false (the correct answer) and 10.7% could not say. The proportion answering ‘true’ was fairly similar in wave 2 at 52.1%. In a multivariate model (that adjusted for demographics, socioeconomic position, mental health and smoking-related beliefs and behaviours), certain groups of smokers were significantly more likely to believe that nicotine was carcinogenic. These included older smokers (≥50 vs <35 years); Māori smokers (vs European/other, adjusted OR (aOR)=1.77, 95% CI 1.22 to 2.58); and Asian smokers (vs European/other, aOR=3.25, 95% CI 1.35 to 7.83).
  • Citation: Wilson N, Peace J, Edwards R, et alSmokers commonly misperceive that nicotine is a major carcinogen: National survey dataThorax 2011;66:353-354.
    • Acknowledgement: This study was funded by the Health Research Council of New Zealand (grant 06/453).

Smoking and Smoking Cessation

• See Also: Smokeless Products

2025: Smoking Cessation Treatment Efficacy and Impact on Health Outcomes among Middle-Aged and Older Adults: A Scoping Review

• A scoping review of RCT studies on the effectiveness and health outcomes of smoking cessation interventions in middle-aged (45-64 years) and older adults (65+ years) yielded a total of 44 relevant articles. Results showed that middle-aged and older adult smokers are just as, if not more successful at quitting smoking than their younger counterparts using a combined intervention of counseling and cessation medications. Many of the studies did not explicitly focus on older adults, but instead focused on medical conditions more prevalent within aging populations. Future research on older adults should clarify age definitions and report stratified analyses by age.
  • 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.

2024: Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults

• E-cigarette use prevalence was highest among the younger adult (18–34) subpopulation, and lowest among the older adult (55+) subpopulation...
• It is not surprising that we did not observe an association among older adults in the present study, since older adults have generally not adopted e-cigarettes (e.g., see Figs. 2 and [21, 61]), precluding any effect on their smoking.
  • Citation: Foxon, F., Selya, A., Gitchell, J. et al. Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults. Harm Reduct J 21, 136 (2024). https://doi.org/10.1186/s12954-024-01056-0
    • Acknowledgement: The previously-published version of this manuscript [22] was funded by JLI. The present, updated version did not receive any JLI funding, and was self-funded by PinneyAssociates.

2023: Trends in US Adult Smoking Prevalence, 2011 to 2022

• In this cross-sectional study of 353 555 adults responding to the 2011 to 2022 National Health Interview Surveys, adults younger than 40 years had dramatic declines in smoking prevalence during the last decade, especially among those with higher incomes. In contrast, relatively slow declines were observed among adults aged 40 to 64 years, with no decrease in smoking among those 65 years or older.
  • 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).

2021: Paper: 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.

2019: Article: Older Smokers Are the Forgotten Victims of Our Vaping Wars

• I’ve since discovered that older smokers, like all of us, have a lot to learn about smoking. Older people are more likely than younger smokers to think that the evidence about the harms of smoking has been exaggerated, and that smoking is something they can do little to change. They are also more likely to inaccurately believe that nicotine is the primary disease-causing ingredient in cigarettes, and that cigarettes without nicotine are safer than those with nicotine.
  • Source: Annie Kleykamp, Filter Magazine

2018: Power Point: Rethinking nicotine across the lifespan: What about the older smoker?

• GFN: Annie Kleykamp, PhD

2017: Article: Some Older Smokers Turn to Vaping. That May Not Be a Bad Idea.

• A retired secretary in her 70s, she’s often the oldest customer in the shop. Not that she cares. What matters is that after ignoring decades of doctors’ warnings and smoking two packs a day, she hasn’t lit up a conventional cigarette in four years and four months...But while the proportion of Americans who smoke continues to decrease — down to 15.1 percent in 2015 — the decline has stalled among older adults.
• Archived Link
  • Source: Paula Span, The New York Times

2017: Article: Vaping Becoming Popular Among Older Smokers

• Public health officials, however, are divided over vaping’s benefits for older smokers. Some say it reduces the harm of smoking and it's better than doing nothing...“Old policies need to be supplemented with policies that encourage substituting e-cigarettes for the far more deadly cigarettes,” said David Levy, a professor of oncology at Georgetown University's School of Medicine and the leader of the study.
  • Source: Beth Brophy, AARP

2011: Paper: The Older Smoker

• Understanding how these age-related differences impact smoking-related outcomes (eg, tobacco withdrawal, acute effects of smoking, treatment efficacy) is limited because research examining older smokers is lacking. In a systematic review of tobacco withdrawal symptoms, the mean (SD) age of participants across 15 studies, chosen for their scientific rigor, was 37.8 (8.1) years.
• PDF Full Paper
  • Citation: Kleykamp, B. A., & Heishman, S. J. (2011). The Older Smoker. JAMA, 306(8). doi:10.1001/jama.2011.1221

Smokeless Products

• See also: Smoking and Smoking Cessation

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

2023: Vaping prevalence and trends: key findings in the 2022-23 NZ Health Survey

• However, the revised framework should also encourage and support people who smoke, particularly those from older age groups, who cannot or do not want to stop using nicotine products, to switch completely to vaping.
  • Authors: Prof Richard Edwards, Dr Janine Nip, Prof Janet Hoek, Assoc Prof Andrew Waa
    • Acknowledgement: All authors are members of ASPIRE Aotearoa and the Department of Public Health, University of Otago, Wellington.

2016: Patterns of Electronic Cigarette Use Among Adults in the United States

• Note: "Older adults" refers to individuals aged 25-64 years.
• Results: Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes.
• Conclusion: Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm.
• PDF Version
  • Citation: Delnevo CD, Giovenco DP, Steinberg MB, Villanti AC, Pearson JL, Niaura RS, Abrams DB. Patterns of Electronic Cigarette Use Among Adults in the United States. Nicotine Tob Res. 2016 May;18(5):715-9. doi: 10.1093/ntr/ntv237. Epub 2015 Nov 2. Erratum in: Nicotine Tob Res. 2024 Dec 23;27(1):163. doi: 10.1093/ntr/ntae234. PMID: 26525063; PMCID: PMC5896829.
    • 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

2021: Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals

• In this middle-aged and elderly Swedish population, current Swedish snus use was not associated with the risk of major heart and valvular diseases, abdominal aortic aneurysm, or CVD mortality in the entire study population, but was linked to an increased risk of stroke in never smokers.
  • Citation: Titova OE, Baron JA, Michaëlsson K, Larsson SC. Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals. BMC Med. 2021 May 7;19(1):111. doi: 10.1186/s12916-021-01979-6. PMID: 33957912; PMCID: PMC8103653.
    • 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

Memory and Cognitive Ability

MIND (Memory Improvement through Nicotine Dosing) Study

• The MIND Study is by far the largest and longest-running study of its kind, testing whether nicotine can improve memory loss.

2013 Nicotine Prevents Synaptic Impairment Induced by Amyloid-β Oligomers Through α7-Nicotinic Acetylcholine Receptor Activation

• Animal Study
• Taken together, these results demonstrate that nicotine prevents memory deficits and synaptic impairment induced by Aβ oligomers. In addition, nicotine improves memory in young APP/PS1 transgenic mice before extensive amyloid deposition and senile plaque development, and also in old mice where senile plaques have already formed.
• PDF Version
  • Citation: Inestrosa, N.C., Godoy, J.A., Vargas, J.Y. et al. Nicotine Prevents Synaptic Impairment Induced by Amyloid-β Oligomers Through α7-Nicotinic Acetylcholine Receptor Activation. Neuromol Med 15, 549–569 (2013). doi: 10.1007/s12017-013-8242-1
    • Acknowledgements: We thank Dr. Rodrigo Varas for his help with the electrophysiological studies of the α7-nAChR. This work was supported by a grant from FONDECYT No 120156 to N.C.I; predoctoral fellowships from CONICYT to G.G.F., M.S.A. F.G.S., J.A.R. and from Fundación Gran Mariscal de Ayacucho to J.Y.V. The Basal Center of Excellence in Science and Technology CARE was funded by CONICYT/PFB 12/2007.

Mental Health

2020 Regulation of aggressive behaviors by nicotinic acetylcholine receptors: Animal models, human genetics, and clinical studies

• Human and Animal Studies
• Clinical trials and case series report anti-aggressive effects of nicotine. Here we argue that the nAChR system, the molecular basis for the global public health problem of tobacco smoking, may also be a key target for modulation of aggressive behaviors. Future research should aim to clarify which forms of aggression are most strongly affected by nAChR modulation, identify the nAChR subtypes, circuits, and neurobiological mechanisms of nicotine action, and determine whether more selective nAChR-active agents can replicate or improve the serenic effects of nicotine, especially with chronic dosing. Given the prevalence of aggressive behaviors across neuropsychiatric disorders affecting the very young to the very old, these studies have the potential to have a significant impact on public health.
• PDF Version
  • Citation: Alan S. Lewis, Marina R. Picciotto, Regulation of aggressive behaviors by nicotinic acetylcholine receptors: Animal models, human genetics, and clinical studies, Neuropharmacology, Volume 167, 2020, 107929, ISSN 0028-3908, doi: 10.1016/j.neuropharm.2019.107929.
    • Acknowledgements: This work was supported by National Institutes of Health grants MH116339 (A.S.L.), MH077681 and DA14241 (M.R.P.).

2018 Nicotine and networks: Potential for enhancement of mood and cognition in late-life depression

• Nicotine improves cognitive performance in clinical and preclinical studies.
• Nicotine may also benefit depressive symptoms and depressive behavior.
• Cognitive and mood benefits may be mediated by nicotinic effect on neural networks.
• Nicotine’s effects on networks may reverse network changes seen in depression.
• Improvement to mood and cognition may particularly benefit older depressed adults.
• Both preclinical and clinical studies support that nicotine and other nAChR agonists can improve depressive behavior, mood, and cognitive performance. nAChR agonists also demonstrate neuropharmacologic effects that oppose the intrinsic network alterations reported in MDD. Through modulation of intrinsic functional networks, nAChR agonists may reduce depressive symptoms, enhance emotional regulation ability, and improve cognitive deficits common in LLD. For these reasons, we propose nAChR agonists as a potential novel treatment for the mood and cognitive symptoms of LLD.
• PDF Version
  • Citation: Gandelman, J. A., Newhouse, P., & Taylor, W. D. (2018). Nicotine and networks: Potential for enhancement of mood and cognition in late-life depression. Neuroscience & Biobehavioral Reviews, 84, 289–298. doi:10.1016/j.neubiorev.2017.08.0
    • Acknowledgement: Supported by NIH grants K24 MH110598 and CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences.

Very Low Nicotine Content Cigarettes

2021: Responses to Gradual and Immediate Reduction of Nicotine in Cigarettes in Young Versus Older Adult Smokers

• Note: "Older" adults were 25+ (Some, maybe all, were not in the age group this page is compiling information on.)
• These results indicate that an immediate reduction in nicotine would result in beneficial effects in both young and older adults. Young adults show less positive subjective effects of smoking following switching to VLNC cigarettes relative to older adults.
  • Citation: Cassidy RN, Tidey JW, Cao Q, Colby SM, McClernon FJ, Smith TT, Dermody S, Koopmeiners JS, Jensen JA, Strayer LG, Donny EC, Hatsukami D. Responses to Gradual and Immediate Reduction of Nicotine in Cigarettes in Young Versus Older Adult Smokers. Nicotine Tob Res. 2021 Aug 18;23(9):1559-1566. doi: 10.1093/ntr/ntab049. PMID: 33754156; PMCID: PMC8372658.
    • 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