New Book Examines What It Takes to Get Older Adults to Quit Smoking

DURHAM, N.C. -- Why do adults in their 50s and 60s continue to smoke cigarettes, despite decades of warnings that it is dangerous to their health? The answer may lie in smokers' personal experience with negative health effects, say researchers at Duke and N.C. State universities in their new book, "The Smoking Puzzle: Information, Risk Perception, and Choice."

The book, published by Harvard University Press, could help public health workers and others in the medical community develop more effective messages to convince older adults to cut back or quit smoking.

The book co-authors are Frank A. Sloan, J. Alexander McMahon Professor of Health Policy and Management and director of Duke's Center for Health Policy, Law and Management; V. Kerry Smith, NCSU Distinguished Professor in the Department of Agricultural and Resource Economics; and Donald H. Taylor Jr., assistant professor at the Center for Health Policy, part of Duke's Terry Sanford Institute of Public Policy.

It has been nearly 40 years since the first U.S. surgeon general's 1964 warning about smoking. "No one can deny there is lots of information about the hazards of smoking," Smith said, "but when those in their 50s and 60s started smoking as youths, the information may have been less clear."

The puzzle for the researchers was why older adults continued to smoke once they had access to so much information about the negative effects of smoking. And if these adults are not getting the right health messages, what can be done to change that? The answers, they discovered, may be directly related to smokers' personal experiences.

"Older adults' decisions to quit smoking require personal experience with a serious health event attributable to smoking, like a heart attack or onset of severe emphysema," Sloan said. "Less serious events, such as onset of difficulty in climbing a few flights of stairs or in walking several blocks, appear insufficient to induce quitting."

Researchers also found that the more personal the message, the more likely it was for smokers to quit. "The notion that smoking kills apparently is not news to most people," Sloan said. "But information about the impact on quality of life of a smoking-related disease is news and does cause smokers to change their perceptions of the risk associated with smoking."

The researchers suggest, therefore, that the best means of reducing smoking among older adults is to develop personalized messages, based on individual habits and circumstances. These messages would be most effective coming from doctors and would change the kind of messages that doctors now provide to patients who smoke.

The message most older smokers hear suggests they still have time to quit smoking and that once they quit, they will become healthy. So mentally they put off quitting until they are in their 60s or until they experience a serious health event, said Smith, who directs N.C. State's Center for Environmental and Resource Economic Policy.

The study is significant because it focuses on an age group that has not been studied well in smoking research, Smith said. Such research traditionally has focused on youth and how to prevent them from starting smoking. The researchers' work was funded by a grant from the Robert Wood Johnson Foundation and administered through the foundation's Substance Abuse Research Program.

The multi-year study began with an analysis of the Health and Retirement Study, a national survey of 22,000 people conducted every two years by the University of Michigan's Institute for Social Research. Those eligible for the study when it began in 1992 were born between 1931 and 1941 and ranged in age from 51 to 61. In 2000, data were available from four rounds of interviews -- 1992, 1994, 1996 and 1998. The study provided information about respondents' smoking habits, as well as their perceptions of longevity and end-of-life care.

A second study group of 250 -- parallel in demographics to the first -- was created in the Raleigh-Durham area for purposes of research on The Smoking Puzzle.  Members of this study group, all smokers, participated in computer-based surveys that included anti-smoking messages.

One group received more personalized messages about health impacts, their future quality of life and possible disabilities, based on their age and smoking habits. A second group received messages focused on refined measures of the increased mortality risks due to smoking. The study found that only those receiving the more personal messages about health and the quality-of-life effects resulting from smoking were likely to reduce the amount they smoked, Smith said.

In addition, groups such as the Lung Association and American Cancer Society may want to consider changing their core messages to inform smokers about the end-of-life disabilities that smoking causes, Smith said.