Journal of Gerontological Nursing

Research Brief 

Tobacco Myths: The Older Adult Perspective

Lana M. Brown, PhD, RN, NEA-BC

Abstract

Twenty adults ages 50 and older who had ceased using tobacco for 1 year or longer were interviewed. Participants provided personal insights into three myths found in the literature surrounding tobacco use and cessation in older adults and were asked to describe any perceived benefits of tobacco use. The findings indicate older adult tobacco users may need additional education on tobacco risks and cessation benefits provided by health care providers during routine office visits. [Journal of Gerontological Nursing, 41(5), 9–13.]

Dr. Brown is Clinical Assistant Professor, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

The author has disclosed no potential conflicts of interest, financial or otherwise. This project was supported by Sigma Theta Tau International, Gamma Xi Chapter. The author thanks Dr. Claudia Barone (dissertation chair) and Drs. Michael Anders, Tammy Jones, Jean McSweeney, and Donna Middaugh (dissertation committee members) along with the participants who willingly shared their insights into tobacco cessation.

Address correspondence to Lana M. Brown, PhD, RN, NEA-BC, Clinical Assistant Professor, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 529, Little Rock, AR 72205; e-mail: brownlanam@uams.edu.

Received: July 06, 2014
Accepted: October 31, 2014
Posted Online: February 05, 2015

Abstract

Twenty adults ages 50 and older who had ceased using tobacco for 1 year or longer were interviewed. Participants provided personal insights into three myths found in the literature surrounding tobacco use and cessation in older adults and were asked to describe any perceived benefits of tobacco use. The findings indicate older adult tobacco users may need additional education on tobacco risks and cessation benefits provided by health care providers during routine office visits. [Journal of Gerontological Nursing, 41(5), 9–13.]

Dr. Brown is Clinical Assistant Professor, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

The author has disclosed no potential conflicts of interest, financial or otherwise. This project was supported by Sigma Theta Tau International, Gamma Xi Chapter. The author thanks Dr. Claudia Barone (dissertation chair) and Drs. Michael Anders, Tammy Jones, Jean McSweeney, and Donna Middaugh (dissertation committee members) along with the participants who willingly shared their insights into tobacco cessation.

Address correspondence to Lana M. Brown, PhD, RN, NEA-BC, Clinical Assistant Professor, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 529, Little Rock, AR 72205; e-mail: brownlanam@uams.edu.

Received: July 06, 2014
Accepted: October 31, 2014
Posted Online: February 05, 2015

Despite these known facts, myths surrounding tobacco use by older adults and cessation benefits may reduce health care provider efforts for cessation interventions or may negatively influence tobacco users’ motivation to quit (Doolan & Froelicher, 2008). These common myths include (a) tobacco provides benefits for older adults, including improved cognition; (b) tobacco damage is irreversible; and (c) older adults do not want to quit (Cataldo, 2007; Wallace, Sairafi, & Weeks, 2006). The purpose of the current study was to explore older adult perspectives regarding these myths and how or if they influenced their decision to quit using tobacco.

Method

Recruitment Method and Sample

Using snowball sampling, 20 adults ages 50 and older who had successfully ceased using tobacco products for 1 year or longer and remained tobacco free were recruited between September 2013 and January 2014 to participate in a qualitative study. The Table shows participant characteristics.

Table:

Participant Characteristics/Responses to Myths (N = 20)

Setting and Data Collection

The study was approved by the overseeing institutional review board and all participants provided informed written consent. Participants were interviewed in their homes with data collected from demographic questionnaires, participant interviews, and field notes. Tobacco products were defined as cigarettes, cigars, pipes, and/or smokeless tobacco. Eighteen participants had used cigarettes, cigars, or pipes, whereas the remaining two used smokeless tobacco products. Participants shared their personal experiences of tobacco use and quitting in face-to-face, semistructured, audiorecorded interviews that lasted 30 to 60 minutes. As part of the interviews, participants were read the following common myths (taken from the literature) related to tobacco use in older adults and were asked to provide any thoughts and insights: (a) tobacco helps you think more clearly, (b) tobacco damage is irreversible, and (c) older adults do not want to quit (Cataldo, 2007; Wallace et al., 2006). Participants were also asked to describe any perceived benefits of tobacco use.

Data Analysis

Data from the demographic questionnaires were analyzed using descriptive statistics. All interviews were transcribed verbatim by an experienced transcriptionist and the accuracy of each transcription was verified by the author. Data from the transcripts were analyzed using content analysis and constant comparison techniques. Content analysis is a systematic method to code and analyze qualitative data, and begins with the first interview, whereas constant comparison is an analysis technique used to compare and contrast themes between interviews (Bernard & Ryan, 2010).

The Table shows participant responses to the three myth statements. For each statement, responses were grouped into three categories depending on whether the participant agreed, disagreed, or was unsure of the statement. Participants’ direct quotes were used to further explain responses for each myth statement.

Results

Myth 1: Tobacco Helps Older Adults Think More Clearly

When the participants were read the statement, “Tobacco makes you think more clearly,” 18 of 20 disagreed. Participants stated, “No, it doesn’t make you think more clearly, that is just an excuse to put it in your mouth,” and “It relaxes you, but it does not help your thinking.” Seven of 18 participants who disagreed believed that tobacco provided a calming or relaxing effect. The two participants who agreed with this statement believed that tobacco made them think more clearly, at least temporarily; one participant said it was “maybe temporarily because it does make you more wide awake for a minute or two.”

Myth 2: Tobacco Damage Is Irreversible

Eleven participants disagreed, six agreed, and three were unsure when asked to comment on the myth claiming “Tobacco damage is irreversible.” Those who disagreed with the statement believed that lung capacity and shortness of breath improved after quitting. One participant said, “Some of the damage is reversible over time. My shortness of breath and exercise tolerance improved remarkably.” Participants who agreed with the myth had been diagnosed with chronic obstructive pulmonary disease (COPD) or emphysema prior to tobacco cessation; their comments included: “Yes, COPD doesn’t get better” and “I would say so because I don’t have the lung capacity I had before. Once the damage is done, it is done.”

Myth 3: Older Adults Do Not Want to Quit

The third myth statement was “Older adults do not want to quit.” The responses were mixed: 10 participants disagreed, six were unsure, and four agreed. One participant who agreed said, “I think some of us do want to quit. We just don’t know how.” Another participant who agreed noted, “I think if they wanted to, they would have already quit.” Participants who were unsure believed they could not answer for others or that the desire to quit varied according to the individual.

Perceived Tobacco Benefits

When these 20 older adults were asked to describe the benefits of tobacco use, the three perceived benefits noted were that tobacco (a) helped control weight gain, (b) helped control anxiety, and (c) improved cognition. Seven participants used tobacco to help alleviate anxiety or stress, six believed tobacco use helped keep them thin, and two believed tobacco made them think more clearly initially after use, but not for an extended period of time. One participant stated, “Your body craves the nicotine [and] then the anxiety begins, [and] a cigarette helps.” Two other participants made similar statements, saying tobacco “kept me trim and slim.” One participant commented, “A cigarette helped me focus.”

Discussion

Most participants (18 of 20) believed tobacco did not improve cognition. According to a recent study by Peters (2012), tobacco use may initially increase cognition due to the effects of nicotine, but long-term tobacco use in older adults may lead to reduced cerebral perfusion and increased white brain matter, cerebral atrophy, and dementia (i.e., vascular and Alzheimer’s). One study including 229 older adult tobacco users and 98 older adult non-tobacco users supports that older adults who continued to use tobacco had significant deterioration in immediate (p = 0.004) and delayed (p = 0.029) recall along with greater cognitive decline (Almeida et al., 2011). In addition, this study indicated tobacco users had significantly more white brain matter on magnetic resonance imaging than both non-tobacco users and those who had quit.

Participants had mixed responses to whether tobacco damage is irreversible. Most (11 of 20) believed some damage is reversible. Growing evidence supports tobacco damage reversal in cardiovascular risk, some pulmonary diseases, and cancer, but only after tobacco cessation (Kerr, Whyte, Watson, Tolson, & McFayden, 2011). Research supports the immediate reversal or reduction in the risk of cardiovascular disease after tobacco cessation, with a 50% decrease in risk within the first year of quitting and further reductions to the equivalent cardiovascular risk of a non-tobacco user within 5 years of cessation (Wipfli & Samet, 2009). A 40% reduction in rehospitalization and a 70% decrease in all-cause mortality in patients with acute cardiac syndrome after tobacco cessation demonstrate an improvement in cardiac health compared to patients who continue to use tobacco (Mohiuddin, Mooss, Grolimes, Cloutier, & Hilleman, 2007; Suskin, Pipe, & Prior, 2008). Evidence suggests that tobacco cessation thwarts the progression of COPD and improves pulmonary function by approximately 5% within months of cessation (Fagerström, 2002; Kerr et al., 2011; USDHHS, 2008). According to COPD clinical practice guidelines, tobacco cessation is viewed as the only intervention that slows or halts the progression of COPD (Qaseem et al., 2011). After cessation, research supports that lung cancer risks steadily decline, reducing by as much as 50% within 10 years of quitting (CDC, 2014). Some research indicates that tobacco cessation may increase the average life expectancy of older adults by 10 years or more, to an equivalent of that of older adults who have never used tobacco products (Kerr et al., 2011). However, almost one half of the participants (9 of 20) did not perceive tobacco damage as reversible.

Participants had a desire to quit using tobacco, but the responses varied when asked for their opinion about the myth statement claiming “Older adults do not want to quit.” Evidence supports that adults ages 50 and older have a greater desire to quit using tobacco products than younger tobacco users (ages 18 to 29) (p < 0.01), especially older adults who have experienced the negative health effects of tobacco (Clark, Hogan, Kviz, & Prochaska, 1999; Wallace et al., 2006). In the United States, 44% of older adult tobacco users have indicated a desire to quit and are interested in health care provider advice and assistance (Abdullah & Simon, 2006).

Research supports that tobacco users ages 50 and older typically use tobacco products daily and have used them regularly for a significantly longer period of time than younger adults (p < 0.0001) (Hall et al., 2008; Ridner, Walker, Hart, & Myers, 2010). Tobacco cessation is considered the most important behavior change to improve health, especially in older adults who commonly have chronic conditions caused by tobacco use.

There is evidence that tobacco cessation has both immediate and long-term health benefits. Despite these known benefits, the results of the current study indicated that participants had mixed ideas related to health benefits. These findings suggest that improved cessation education, especially for its benefits, may be needed for older adults. Health care providers have the best opportunity to provide this education during routine office visits as well as providing print educational materials.

Study Limitations

A number of study limitations need to be noted. The sample was 90% Caucasian and 10% African American, with all participants speaking English; therefore, the study lacked diversity. All participants were tobacco-free and quit using it when they were 50 or older, which is defined as an older adult according to the USDHHS (2008); this may not be the age definition perceived by other organizations or individuals. Participants may not have considered themselves older adults at the time of quitting. The findings may vary for tobacco users and non-users because this study only included participants who had ceased using tobacco. Lastly, most participants had quit using tobacco for a long-term period, meaning responses may have varied according to length of tobacco cessation.

Implications for Practice

Every tobacco user should be screened by a health care provider for tobacco use and intention to quit and provided tobacco-related education and therapeutic interventions as indicated by individual intent (Riesco Miranda, Jimenez Ruiz, & Serrano Rebollo, 2013). Motivational interviewing is recommended at every visit to assess for tobacco use and should include the “5 Rs” (i.e., relevance, risks, rewards, roadblocks, and repetition) to enhance future attempts to quit (Riesco Miranda et al., 2013). Assessment of the 5 Rs by a health care provider examines factors that may be useful in assisting the tobacco user toward a cessation attempt (Sarna, Bialous, Ong, Wells, & Kotlerman, 2012).

Myths surrounding tobacco use and cessation may affect the attitudes and beliefs of older adult tobacco users. These study findings revealed varied older adult perceptions regarding the benefits of tobacco as well as the immediate and long-term health benefits of tobacco cessation, and indicated the possible need for increased education for older adults surrounding risks of tobacco use as well as the benefits of cessation provided by a health care provider. Motivational interviewing provides each health care provider an opportunity to educate older adult tobacco users on the risks of tobacco use and the benefits of quitting. It is important for older adult tobacco users to know the health risks of tobacco use, the potential for health improvement and tobacco damage reversal with quitting, and the benefits of quitting from older adults who have experienced tobacco cessation and maintained abstinence.

References

  • Abdullah, A. & Simon, J. (2006). Health promotion in older adults: Evidence-based smoking cessation programs for use in primary care settings. Geriatrics, 61, 30–34.
  • Almeida, O.P., Garrido, G.J., Alfonso, H., Hulse, G., Lautenschlager, N.T., Hankey, G.J. & Flicker, L. (2011). 24-month effect of smoking cessation on cognitive function and brain structure in later life. Neuroimage, 55, 1480–1489. doi:10.1016/j.neuroimage.2011.01.063 [CrossRef]
  • Bernard, H.R. & Ryan, G.W. (2010). Analyzing qualitative data: Systematic approaches. Thousand Oaks, CA: Sage.
  • Cataldo, J. (2007). Clinical implications of smoking and aging: Breaking through the barriers. Journal of Gerontological Nursing, 33(8), 30–34.
  • Centers for Disease Control and Prevention. (2014). Best practices for comprehensive tobacco control programs. Retrieved from http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/overall-fact-sheet.pdf
  • Clark, M.A., Hogan, J.W., Kviz, F.J. & Prochaska, T.R. (1998). Age and the role of symptomatology in readiness to quit smoking. Addictive Behavior, 24, 1–16. doi:10.1016/S0306-4603(98)00030-6 [CrossRef]
  • Doolan, D.M. & Froelicher, E.S. (2008). Smoking cessation interventions and older adults. Progress in Cardiovascular Nursing, 23, 119–127. doi:10.1111/j.1751-7117.2008.00001.x [CrossRef]
  • Fagerström, K. (2002). The epidemiology of smoking: Health consequences and benefits of cessation. Drugs, 62, 1–9. doi:10.2165/00003495-200262002-00001 [CrossRef]
  • Flatt, J.D., Agimi, Y. & Albert, S.M. (2012). Homophily and health behavior in social networks of older adults. Family Community Health, 35, 312–321. doi:10.1097/FCH.0b013e3182666650 [CrossRef]
  • Hall, S., Humfleet, G., Gorecki, J., Munoz, R., Reus, V. & Prochaska, J. (2008). Older versus younger treatment-seeking smokers: Differences in smoking behavior, drug and alcohol use, and psychosocial and physical functioning. Nicotine & Tobacco Research, 10, 463–470. doi:10.1080/14622200801901922 [CrossRef]
  • Kerr, S., Whyte, R., Watson, H., Tolson, D. & McFayden, A.K. (2011). A mixed-methods evaluation of the effectiveness of tailored smoking cessation training for healthcare practitioners who work with older people. Worldviews on Evidence-Based Nursing, 8, 177–186. doi:10.1111/j.1741-6787.2011.00219.x [CrossRef]
  • Mohiuddin, S.M., Mooss, A.N., Grolimes, T.L., Cloutier, D.A. & Hilleman, D.E. (2007). Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease. Chest, 131, 446–452. doi:10.1378/chest.06-1587 [CrossRef]
  • Peters, R. (2012). Blood pressure, smoking, and alcohol use, association with vascular dementia. Experimental Gerontology, 47, 865–872. doi:10.1016/j.exger.2012.05.018 [CrossRef]
  • Qaseem, A., Wilt, T.J., Weinberger, S.E., Hannania, N.A., Criner, G., van der Molen, T., Marciniuk, D. & Schekelle, P. (2011). Diagnosis and management of stable chronic obstructive pulmonary disease: A clinical practice update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Annals of Internal Medicine, 155, 179–191. doi:10.7326/0003-4819-155-3-201108020-00008 [CrossRef]
  • Ridner, S.L., Walker, K.L., Hart, J.L. & Myers, J.A. (2010). Smoking identities and behavior: Evidence of discrepancies, issues for measurement and intervention. Western Journal of Research, 32, 436–446. doi:10.1177/0193945909354904 [CrossRef]
  • Riesco Miranda, J.A., Jimenez Ruiz, C.A. & Serrano Rebollo, J.C. (2013). Smoking cessation: Update. Clinical Pulmonary Medicine, 20, 129–136. doi:10.1097/CPM.0b013e31828fda4c [CrossRef]
  • Sarna, L., Bialous, S., Ong, M., Wells, M. & Kotlerman, J. (2012). Nurses’ treatment of tobacco dependence in hospitalized smokers in three states. Research in Nursing & Health, 35, 250–264. doi:10.1002/nur.21476 [CrossRef]
  • Suskin, N., Pipe, A. & Prior, P. (2008). Smokers paradox or not in heart failure. Just quit. European Heart Journal, 29, 1932–1933. doi:10.1093/eurheartj/ehn275 [CrossRef]
  • U.S. Department of Health and Human Services. (2008). Treating tobacco use and dependence: Clinical practice guidelines, 2008 update. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf
  • U.S. Department of Health and Human Services. (2014). The health consequences of smoking-50 years of progress: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf
  • Wallace, A., Sairafi, N. & Weeks, W. (2006). Tobacco cessation counseling across the ages. Journal of the American Geriatrics Society, 54, 1425–1428. doi:10.1111/j.1532-5415.2006.00843.x [CrossRef]
  • Wipfli, H. & Samet, J.M. (2009). Global economic and health benefits of tobacco control: Part 1. Clinical Pharmacology & Therapeutics, 86, 263–271. doi:10.1038/clpt.2009.93 [CrossRef]

Participant Characteristics/Responses to Myths (N = 20)

Characteristic n (%)
Gender
  Male 11 (55)
  Female 9 (45)
Race
  Caucasian 18 (90)
  African American 2 (10)
State currently living
  Arkansas 15 (75)
  Louisiana 3 (15)
  Texas 2 (10)
Quit age (average = 60.5)
  50 to 59 12 (60)
  60 to 69 8 (40)
Age at interview (average = 71.5)
  50 to 59 1 (5)
  60 to 69 8 (40)
  70 to 79 10 (50)
  80 to 89 1 (5)
Years of tobacco use (average = 42)
  25 to 29 1 (5)
  30 to 39 6 (30)
  40 to 49 9 (45)
  50 to 55 4 (20)
Years of tobacco cessation (average: 11.2)
  1 to 9 7 (35)
  10 to 19 10 (50)
  20 to 29 2 (10)
  30 1 (5)
Highest level of education completed
  9th to 11th grade 1 (5)
  12th grade/GED 9 (45)
  Some college/vocational school 6 (30)
  College graduate 4 (20)
Myth statement
  Tobacco helps you think more clearly
    Disagree 18 (90)
    Agree 2 (10)
  Tobacco damage is irreversible
    Disagree 11 (55)
    Agree 6 (30)
    Unsure 3 (15)
  Older adults do not want to quit
    Disagree 10 (50)
    Agree 4 (20)
    Unsure 6 (30)

10.3928/00989134-20150127-02

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