The Impact of Older Age on Smoking Cessation Outcomes After Standard Advice to Quit

Abstract

Older adults are a high priority population for smoking cessation. This study observed the influence of older age on the relationship between quitting predictors and cessation. Secondary analysis was conducted of a primary care trial of adults who smoke cigarettes randomized to standard advice to quit or advice plus 2 week supply of nicotine replacement therapy. Logistic regressions assessed interactions of age (<60 vs. ≥ 60 years) by predictors in relation to quit attempts and 6-month cessation controlling for treatment. Predicting quit attempts, there was an interaction of age by motivation (p = .025) and trend of age by nicotine dependence (p = .057). Predicting 6-month cessation, an interaction of age by motivation was observed (p = .020) and a trend of age by dependence (p = .067). For those with high nicotine dependence, older adults had less successful outcomes compared to younger counterparts. Yet among participants unmotivated to quit, older adults had more successful outcomes than those younger.

Keywords

tobacco cessation geriatric health primary care smoking cessation

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References

Adams

J. M.

(2020). Smoking cessation-progress, barriers, and new opportunities: The surgeon general’s report on smoking cessation. JAMA, 323(24), 2470–2471. https://doi.org/10.1001/jama.2020.6647

Alzheimer’s Association . (2022). Alzheimer’s disease facts and Figures. Alzheimers Dement, 18, 13–15. https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf.

Arancini

Borland

Le Grande

Mohebbi

Dodd

Dean

O. M.

Berk

McNeill

Fong

G. T.

Cummings

K. M.

Cummings

K. M.

(2021). Age as a predictor of quit attempts and quit success in smoking cessation: Findings from the international tobacco control four-country survey (2002–14). Addiction, 116(9), 2509–2520. https://doi.org/10.1111/add.15454

Babb

Malarcher

Schauer

Asman

Jamal

(2017). Quitting smoking among adults—United States, 2000–2015. MMWR. Morbidity and Mortality Weekly Report, 65(52), 1457–1464. https://doi.org/10.15585/mmwr.mm6552a1

Baumgart

Snyder

H. M.

Carrillo

M. C.

Fazio

Kim

Johns

(2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer’s and Dementia: The Journal of the Alzheimer's Association, 11(6), 718–726. https://doi.org/10.1016/j.jalz.2015.05.016

Borland

Yong

H. H.

O’Connor

R. J.

Hyland

Thompson

M. E.

(2010). The reliability and predictive validity of the heaviness of smoking index and its two components: Findings from the international tobacco control four country study. Nicotine and Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 12(Suppl 1), S45–S50. https://doi.org/10.1093/ntr/ntq038

Burris

J. L.

Heckman

B. W.

Mathew

A. R.

Carpenter

M. J.

(2015). A mechanistic test of nicotine replacement therapy sampling for smoking cessation induction. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 29(2), 392–399. https://doi.org/10.1037/adb0000035

Carpenter

M. J.

Wahlquist

A. E.

Dahne

Gray

K. M.

Garrett‐Mayer

Cummings

K. M.

Davis

Egan

B. M.

(2020). Nicotine replacement therapy sampling for smoking cessation within primary care: Results from a pragmatic cluster randomized clinical trial. Addiction, 115(7), 1358–1367. https://doi.org/10.1111/add.14953

Cawkwell

P. B.

Blaum

Sherman

S. E.

(2015). Pharmacological smoking cessation therapies in older adults: A review of the evidence. Drugs and Aging, 32(6), 443–451. https://doi.org/10.1007/s40266-015-0274-9

10.

Chen

L. T.

(2015). Smoking cessation interventions for adults aged 50 or older: A systematic review and meta-analysis. Drug and Alcohol Dependence, 154, 14–24. https://doi.org/10.1016/j.drugalcdep.2015.06.004.

11.

Cohen-Mansfield

(2016). Predictors of smoking cessation in old–old age. Nicotine and Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 18(7), 1675–1679. https://doi.org/10.1093/ntr/ntw011

12.

Cornelius

M. E.

Loretan

C. G.

Wang

T. W.

Jamal

Homa

D. M.

(2022). Tobacco product use among adults—United States, 2020. MMWR. Morbidity and Mortality Weekly Report, 71(11), 397–405. https://doi.org/10.15585/mmwr.mm7111a1

13.

Dahlhamer

Lucas

Zelaya

Nahin

Mackey

DeBar

Kerns

Von Korff

Porter

Helmick

(2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR. Morbidity and Mortality Weekly Report, 67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

14.

Dahne

Wahlquist

A. E.

Boatright

A. S.

Garrett-Mayer

Fleming

D. O.

Davis

Egan

Carpenter

M. J.

(2018). Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial. Contemporary Clinical Trials, 72, 1–7. https://doi.org/10.1016/j.cct.2018.07.008.

15.

Donze

Ruffieux

Cornuz

(2007). Determinants of smoking and cessation in older women. Age and Ageing, 36(1), 53–57. https://doi.org/10.1093/ageing/afl120

16.

Durazzo

T. C.

Mattsson

Weiner

M. W.

Alzheimer’s Disease Neuroimaging Initiative (2014). Smoking and increased Alzheimer's disease risk: A review of potential mechanisms. Alzheimer’s and Dementia: The Journal of the Alzheimer's Association, 10(3 Suppl), S122–S145. https://doi.org/10.1016/j.jalz.2014.04.009

17.

Heatherton

T. F.

Kozlowski

L. T.

Frecker

R. C.

Rickert

Robinson

(1989). Measuring the heaviness of smoking: Using self‐reported time to the first cigarette of the day and number of cigarettes smoked per day. British Journal of Addiction, 84(7), 791–799. https://doi.org/10.1111/j.1360-0443.1989.tb03059.x

18.

Henley

S. J.

Asman

Momin

Gallaway

M. S.

Culp

M. B.

Ragan

K. R.

Richards

T. B.

Babb

(2019). Smoking cessation behaviors among older US adults. Preventive Medicine Reports, 16, 100978. https://doi.org/10.1016/j.pmedr.2019.100978.

19.

Hsu

C. L.

Hsueh

K. C.

Chou

M. Y.

H. C.

Mar

G. Y.

Chen

H. J.

West

(2018). Long-term smoking cessation rates in elderly versus other adult smokers: A 3-year follow-up study in Taiwan. Addictive Behaviors Reports, 8, 62–65. https://doi.org/10.1016/j.abrep.2018.07.001.

20.

Huddlestone

Walker

G. M.

Hussain-Mills

Ratschen

(2015). Treating tobacco dependence in older adults: A survey of primary care clinicians’ knowledge, attitudes, and practice. BMC Family Practice, 16(1), 97–99. https://doi.org/10.1186/s12875-015-0317-7

21.

Hughes

J. R.

Keely

J. P.

Niaura

R. S.

Ossip-Klein

D. J.

Richmond

R. L.

Swan

G. E.

(2003). Measures of abstinence in clinical trials: Issues and recommendations. Nicotine and Tobacco Research, 5(1), 13–26. https://doi.org/10.1080/1462220031000070552

22.

Hyland

Borland

Yong

H. H.

McNeill

Fong

G. T.

O’Connor

R. J.

Cummings

K. M.

(2006). Individual-level predictors of cessation behaviours among participants in the international tobacco control (ITC) four country survey. Tobacco Control, 15(suppl 3), iii83–iii94. https://doi.org/10.1136/tc.2005.013516

23.

Isenberg

J. Y.

Quiñones

A. R.

Slatore

C. G.

Bryson

W. C.

Thielke

S. M.

(2016). Trends in cigarette smoking and cessation among Medicare managed care recipients, 2005–2012. Addictive Behaviors, 58, 155–160. https://doi.org/10.1016/j.addbeh.2016.02.037.

24.

Jardin

B. F.

Cropsey

K. L.

Wahlquist

A. E.

Gray

K. M.

Silvestri

G. A.

Cummings

K. M.

Carpenter

M. J.

(2014). Evaluating the effect of access to free medication to quit smoking: A clinical trial testing the role of motivation. Nicotine and Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 16(7), 992–999. https://doi.org/10.1093/ntr/ntu025

25.

Kaufman

Augustson

Davis

K. I. A.

Finney Rutten

L. J.

(2010). Awareness and use of tobacco quitlines: Evidence from the health information national trends survey. Journal of Health Communication, 15 Suppl 3(0 3), 264–278. https://doi.org/10.1080/10810730.2010.526172

26.

Kleykamp

B. A.

Kulak

J. A.

(2023). Cigarette use among older adults: A forgotten population. American Journal of Public Health, 113(1), 27–29. https://doi.org/10.2105/AJPH.2022.307151.

27.

Kulak

J. A.

LaValley

(2018). Cigarette use and smoking beliefs among older Americans: Findings from a nationally representative survey. Journal of Addictive Diseases, 37(1-2), 46–54. https://doi.org/10.1080/10550887.2018.1521255

28.

Lindson

Chepkin

S. C.

Fanshawe

T. R.

Bullen

Hartmann‐Boyce

(2019). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 2019(4). https://doi.org/10.1002/14651858.cd013308

29.

McAfee

Malone

R. E.

Cataldo

(2021). Ignoring our elders: Tobacco control’s forgotten health equity issue. Tobacco Control, 30(5), 479–480. https://doi.org/10.1136/tobaccocontrol-2021-056945

30.

Medicare.gov (2022). Counseling to prevent tobacco use and tobacco-caused disease. https://www.medicare.gov/coverage/counseling-to-prevent-tobacco-use-tobacco-caused-disease#:∼:text=Counseling_to_prevent_tobacco_use_%26_tobacco%2Dcaused_disease

31.

Ortman

J. M.

Velkoff

V. A.

Hogan

(2014) An aging nation: the older population in the United States, current population reports (P25-1140). US Census Bureau.

32.

Pérez-Ríos

Santiago-Pérez

M. I.

Alonso

Malvar

Hervada

de Leon

(2009). Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey. BMC Public Health, 9(1), 493–495. https://doi.org/10.1186/1471-2458-9-493

33.

Rimer

B. K.

Orleans

C. T.

Keintz

M. K.

Cristinzio

Fleisher

(1990). The older smoker: Status, challenges and opportunities for intervention. Chest, 97(3), 547–553. https://doi.org/10.1378/chest.97.3.547

34.

Rojewski

A. M.

Tanner

N. T.

Dai

Ravenel

J. G.

Gebregziabher

Silvestri

G. A.

Toll

B. A.

(2018). Tobacco dependence predicts higher lung cancer and mortality rates and lower rates of smoking cessation in the National Lung Screening Trial. Chest, 154(1), 110–118. https://doi.org/10.1016/j.chest.2018.04.016

35.

Substance Abuse and Mental Health Services Administration. (2020). Treating substance use disorder in older adults. Treatment improvement protocol. (TIP 26).

36.

Tait

R. J.

Hulse

G. K.

Waterreus

Flicker

Lautenschlager

N. T.

Jamrozik

Almeida

O. P.

(2007). Effectiveness of a smoking cessation intervention in older adults. Addiction, 102(1), 148–155. https://doi.org/10.1111/j.1360-0443.2006.01647.x

37.

Warren

G. W.

Alberg

A. J.

Kraft

A. S.

Cummings

K. M.

(2014). The 2014 surgeon general's report: “The health consequences of smoking–50 Years of progress”: A paradigm shift in cancer care. Cancer, 120(13), 1914–1916. https://doi.org/10.1002/cncr.28695

38.

World Health Organization . (2019). Ageing. https://www.who.int/health-topics/ageing#tab=tab_1