This is the first study to investigate tobacco industry activity in relation to older persons, and it shows that the tobacco industry has aggressively targeted older people and aging Baby Boomers. There is documentation that the tobacco industry used some “light” cigarettes to initiate young adults into smoking 108
. However, what is unique about the industry’s targeting of older smokers is the focus on aggressively marketing “light” and “low-tar” cigarettes as an alternative to quitting, and the false implication that they were a healthier choice.
Our study has limitations. We may not have retrieved every relevant document, due to database size and indexing limitations. Some materials may have been destroyed or concealed by tobacco companies 109
; others may have never been obtained in the legal discovery process. Post 1998, tobacco companies were aware that documents might eventually be made public. All archival research requires that decisions be made about which aspects and which materials to cite as representative; it is possible that other researchers might find other themes more interesting or informative. Despite these limitations, our study points to several previously unexamined aspects affecting the context within which older smokers may consider quitting.
Smokers of “light” brands are misinformed about the disease risks of using low-tar cigarettes. 110, 111
Lung cancer risk, for example, is no different in smokers of “light” or “low tar” cigarettes. 25
“Low tar” cigarettes deliver high levels of nicotine 74
and do not encourage smoking cessation 112
, partly because smokers vary their puffing to regulate nicotine levels and compensate for low yield cigarettes by smoking them more intensely. 113
Thus, tar and nicotine delivered is greater than the machine smoked yields reported to consumers and regulators. 113
Although the truth about low tar cigarettes began to emerge in public health literature in the late 1990’s, the tobacco industry was aware of these issues as early as 1980. 71
In 2006, major U.S. tobacco companies, including those discussed here, were convicted in federal court of fraud and racketeering. The presiding judge concluded:
“…Defendants falsely marketed and promoted low tar/light cigarettes as less harmful than full-flavor cigarettes in order to keep people smoking and sustain corporate revenues”. 110
Educating older smokers about the tobacco industry’s influence on smoking behaviors may impact self-blame, a documented barrier to cessation 114
. Informing practitioners about industry influence may decrease their tendency to “blame the victim” 115, 116
, thereby increasing the likelihood that they may recommend tobacco addiction treatment for older adults. Informing older smokers, especially those using low-tar cigarettes, of the roles that the tobacco industry had in maintaining their tobacco addiction, emphasizing the level of risk and the health benefits of quitting even in later life, and informing older smokers that low-tar cigarettes confer no reduction in harm and may even make quitting more difficult, should be part of cessation counseling for this population.
The tobacco industry has long claimed that smoking is a “choice”. 11
However, as this study shows, the industry sought to thwart the “choice” of older smokers wanting to quit, working to exploit every identifiable vulnerability in order to keep them smoking. The tobacco industry’s interest in older smokers contrasts with the relative lack of interest shown by many health care providers in helping older smokers quit 8–10, 34, 35
. Practitioners must recognize that the industry’s efforts to retain older smokers affect both their patients’ behavior and the context of cessation counseling. Receiving marketing materials by mail, for example, may deter smokers from quitting and should be addressed in anticipatory guidance.
This study also points to tobacco industry research findings that might be considered by health care practitioners and public health advocates working on ways to reach aging smokers. For example, industry research showed that Baby Boomers’ characteristics included the desire to have control over their lives 43, 50
and a responsiveness to messages suggesting independence and individuality. 52
These characteristics could bear a relationship to the self-exempting and/or self-blaming beliefs of older smokers. 6, 7, 117, 118
The industry’s efforts to emphasize “choice,” while denying or discounting nicotine addiction, may have shaped and reinforced these beliefs. Framing smoking cessation as a route to being in control and remaining more independent in later life might be effective.
As the population ages, all practitioners must make smoking cessation a priority for older patients’ care. Better understanding the industry’s influence on the context of cessation attempts may make these efforts more likely to succeed. Comprehensive tobacco control measures must address all populations across the life span and include a focus on older smokers.