Category: Social and Community Context

22 - Harm Reduction and the Older Smoker

Tobacco smoking, the leading preventable cause of death and disease in the world, is at a record low for young people in the United States (US) having dropped an unprecedented 46.6% for 18 to 24-year olds in recent years (24.4% in 2005 to 13% in 2015 according to the National Health Interview Survey).  Rates of smoking among high school students and adults (25-64 years) have also significantly decreased during the same time. In contrast, smoking prevalence has not changed considerably for older smokers (>= 65 years) in over 25 years (12.8% in 1990 to 8.8% in 2016).  The goal of this literature review is to provide an overview of the published literature on older smokers with a focus on harm reduction and social stigma.

PubMed and Google scholar databases were searched for articles published between January 2003 to January 2018 using terms aging or “older smoker” or aging combined with tobacco, smoking, or nicotine.  Articles were categorized into the following content areas: smoking prevalence, perceptions or beliefs about smoking/cessation, health effects, reducing/stopping smoking, and harm reduction. 

Older smokers have smoked for more years, made fewer quit attempts, and are more likely to endorse reducing smoking rather than quitting compared to younger cohorts.  Unique health issues associated with being an older smoker included comorbid psychiatric or physical health issues, shame and social isolation, cognitive dysfunction, and use of multiple prescription medications.  Older smokers were more likely to believe the misconception that nicotine is the most dangerous component of cigarettes and are less likely to use harm reduction products such as vaporized nicotine. 

Reducing or quitting the use of smoked tobacco at any age has immediate and long-term health benefits.  Older smokers face unique health consequences and challenges associated with stopping smoking including social stigma.  Harm reduction principles might be particularly well suited for assisting older smokers with reducing or stopping their use of combustible tobacco products.  Such approaches might include clear public health and medical communication targeted to older cohorts clarifying the relative risks of varying nicotine and tobacco products, and supporting the autonomy of the older smoker as they navigate their health and well-being.


Bethea Kleykamp

Bethesda, Maryland

Bethea Kleykamp received her PhD in Experimental Psychology in 2007 and then completed two postodoctoral fellowships at the Johns Hopkins University School of Medicine (2010) and the National Institutes on Drug Abuse in (2011). She is currently employed by the healthcare consulting firm PinneyAssociates as a Scientist where she conducts literature reviews, interprets and synthesizes data, and applies her science writing skills to meet a variety of client needs (e.g., Rx-to-OTC switch, risk management, tobacco harm minimization). PinneyAssociates is a public-health focused, science-based healthcare consulting company with offices in Bethesda, MD, and Pittsburgh, PA, providing health policy, scientific, and regulatory support to the pharmaceutical and consumer healthcare industry. We also provide consulting services to Reynolds American, Inc (RAI). Our work for RAI focuses on products, regulations, and policies related to smoking cessation and harm minimization; we do not work on combustible conventional cigarettes.