Older smokers (age 50+) were heavier smokers than younger individuals. They reported experiencing less stress, better moods, and better mental health than the younger smokers. There was no difference in their levels of social involvement. There were no significant differences in alcohol consumption between the two groups. However, their marijuana use, especially that of the female subjects, was less than that of smokers under 50 years of age. Although these differences reached the preset levels of significance, for the most part they were numerically small since the large sample size provided considerable power.
Despite the small differences, the differences between older and younger smokers on psychosocial variables are consistent. Older smokers’ report of their mood states, stressors, and mental health status may have implications for the design of treatment programs. For example, smokers under 50 may experience episodes of poor mood more frequently and be more likely to relapse in response to them simply due to increased event frequency. Emphasis on mood management may be less important for older smokers.
The smoking behavior of older smokers has changed in the past decade. Earlier studies reported mean numbers of cigarettes smoked ranging from approximately 23–27. The mean in the current study was approximately 21, which, while higher than younger smokers entering the clinic, is below that reported previously. Similarly, in the current study approximately 20% of older smokers reported smoking 25 or more cigarettes per day, while previous studies had reported ranges from 35–50%. On other smoking behavior measures, however, subjects entering our clinic were similar to those of 16 years ago. They had smoked for approximately 38 years. Approximately 70% smoked within 30 minutes of arising, within the range reported earlier. They remain a likely population for treatment with NRT, since their level of cigarette intake and years of smoking are higher than for younger smokers.
In both groups, the percentage of individuals with alcohol abuse or dependence is high. Clinically, staff reported that many participants were members of Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). This could reflect variables unique to our clinic—for example, word of mouth referrals among AA attendees. We have no evidence this occurred, however.
Another surprising observation was the high percentage of potential smokers excluded from both studies due to antidepressant use, approximately 23–24% in both studies. There was nothing in the materials used to solicit participants that should have differentially attracted those with depressive disorders or using antidepressants. Neither the clinic nor the studies were identified as being associated with the Department of Psychiatry.
Older smokers smoked slightly more cigarettes than younger smokers, yet a smaller proportion had a nicotine dependence or a nicotine withdrawal diagnosis. There were no significant differences between the age groups in days of drinking or amount per day, yet the older smokers were less likely to have a diagnosis of alcohol dependence or abuse on the C-DIS. These findings led to informal examination of differences in endorsement rates of smokers in the two different age categories for diagnostic category on the C-DIS. The differences on the Alcohol Abuse section of the C-DIS appeared to be driven by a single item concerning the interference of drinking or withdrawal symptoms functioning in school. Examination of the items that comprise the Nicotine Withdrawal diagnosis suggested that older individuals were less likely to endorse subjective withdrawal symptoms than younger smokers. Examination of the Nicotine Dependence and Alcohol Dependence sections of the C-DIS did not provide information that could lead to a more systematic examination of the differences between the two age groups.
Differences between smokers 50 and older and those under 50, even those that were significant, were small. This finding calls into question the Practice Guidelines use of age 50 as the dividing line for older smokers. We did inspect our data to determine whether a different age (for example, 65) would provide a better cut-point, but none emerged. A study in a larger, population based sample, might provide an useful estimate, however. On the other hand, variables correlated with age, such as level of tobacco dependence, may be more important in designing treatment programs than age itself.
Generalization is limited by the restricted nature of the sample, that is, smokers applying to a university based smoking research clinic in an urban setting. This may differentially affect the smokers aged 50 years and older, since problems with mobility may have precluded participation by those in the very oldest age groups who may have concerns that would limit their participation; for example, traveling to the clinic. Nevertheless, they are suggestive of both differences and similarities between the two age groups that should be further explored in the general population.