New study finds older Americans left behind by decades of smoking cessation progress

New R Street Study: Policies To Help Close the Smoking Cessation Gap for Older Adults

A new analysis finds stagnating smoking cessation rates among older adults demand age-specific policy reform and harm reduction pathways

WASHINGTON, D.C. — Today, the R Street Institute released a new study, “Addressing the Stagnation of Smoking Cessation in Older Adults: Behavioral Barriers, Harm Reduction, and Policy Reform.” The study examines why older Americans, who are the most burdened by tobacco-related disease, have benefited least from the dramatic decline in U.S. smoking rates over the past several decades, and what policymakers can do to change that.

The study is authored by Jeffrey S. Smith, a resident senior fellow with R Street’s Healthier Communities program. In it, he explores the behavioral and psychosocial barriers that make cessation uniquely difficult for long-term smokers, the evidence base for tobacco harm reduction alternatives, and a layered set of policy recommendations spanning clinical care, insurance coverage, provider training, and public education.

While adult smoking prevalence has fallen dramatically—from more than 40 percent in the early 1960s to under 10 percent today—that progress has stalled for older adults. Cigarette smoking did not decline among adults 65 and older between 2011 and 2022, and the absolute number of older smokers actually grew during that period.

The study identifies several compounding barriers driving this trend, including deeply entrenched habits formed over 30 to 50 or more years of smoking, financial strain that undermines attempts to quit, social isolation, widespread misperceptions about the relative risks of alternative nicotine products, and a clinical workforce that often lacks the training to offer effective, individualized cessation support. The paper argues that this population requires a fundamentally different policy architecture that is tailored to their specific circumstances rather than one-size-fits-all approaches.

Smith’s recommendations include strengthening access to evidence-based first-line cessation treatments, building a supervised harm reduction pathway for smokers who have repeatedly tried and failed to quit through conventional means, aligning Medicare and Medicaid coverage of cessation medications, developing targeted public education to correct risk misperceptions among older adults, and reforming provider training to address significant gaps in nicotine science and geriatric addiction medicine.

As Smith writes, “The stagnation of smoking cessation among older Americans is not an inevitable consequence of aging; it is a policy failure that targeted reform can address.”

If you would like to speak to the author of this study, please contact pr@rstreet.org.