Adoption of E-Cigarettes Among Older Adults Who Smoke to Reduce Harm and Narrow Age-Related Disparities: An Application of the Health Belief Model

While the prevalence of combusted cigarette (CC) smoking among all other age groups of U.S. adults decreased between 2005 and 2020, the prevalence for those age ≥55 years remained stagnant.1,2 Indeed, 2021 estimates from the National Health Interview Survey (NHIS) suggest current smoking is as prevalent among adults ages ≥65 years (9.4%; 95% Confidence interval = 8.4, 10.5) as it is among adults ages 18–34 years (9.6%; 95% CI = 8.4, 11.0).3 Smoking in older adults carries burdensome health consequences: Among adults ≥65 years who report current cigarette smoking, 25.7% report smoking-related cancer and 46.9% report another smoking-related chronic disease.4 Furthermore, according to 2017 NHIS data, past-year quit attempts are less prevalent among adults 45–64 years (49.6%) and ≥65 years (47.2%) compared to adults 25–44 years (59.8%) as is the prevalence of quit interest (53.7%, 68.7%, and 72.7%, respectively).5 Older adults struggle with smoking cessation: Only 5% of adults ≥65 years who smoke successfully quit in the past year.4 The tobacco industry has played a role in these rates; they aggressively marketed “light” and “low-tar” cigarettes towards older adults while discouraging quitting and providing cigarettes at senior clubs and nursing homes.6