Rethinking Tobacco Use Among Older Populations: Biological and Psychological Considerations

Purpose of Review: This review examines why smoking persists among older adults and identifies mechanisms that impede cessation, with implications for research, treatment, and policy. Recent Findings: We synthesized evidence across five mechanistic domains (withdrawal, dependence, conditioning, motivation, and knowledge) to examine age-related considerations for tobacco use and cessation among older populations (50 years and older). Evidence indicates that older adults often have longer smoking histories, higher nicotine dependence, more entrenched behavioral conditioning, reduced motivation to quit, lower perceived susceptibility to harm, and higher misperceptions of the relative risk of tobacco products. These age-specific mechanisms may diminish treatment responsiveness and limit the effectiveness of standard cessation approaches. Summary: Persistent smoking among older adults reflects unique neurobiological and psychological driversthat remain poorly addressed by current interventions. This lack of clarity is driven by the underrepresentation of adults aged 60 and older intobacco research and cessation trials. Research investment in studying older adults who use tobacco is urgently needed to guide thedevelopment of age-tailored tools that can address the harms of tobacco smoking in this growing population.