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Smoking behaviours and beliefs of older Australians

Smoking behaviours and beliefs of older Australians Penny Kent and Lyn Roberts South Australian Smoking and Health Project, Adelaide Neville Owen Department of Human Movement Science, Deakin University, Melbourne Abstract: Reviews of the effects of smoking on health have concluded that older smokers can experience considerable health benefits from giving up smoking. In a representative population survey of people aged 15 years and over in South Australia, the percentage of people aged 60 years and over who were smokers was 13.5 per cent (95 per cent confidence interval 10.9 to 16.2 per cent). Compared with smokers aged under 60 years (n=727), older smokers (n=88)were significantly more likely: to be less convinced of the effects of smoking on health; to perceive that they were not personally at risk from their o smoking in the future; to believe that smoking had not affected their own health s far; and to believe there was a daily level of cigarette consumption that was safe. Strategies to encourage older people to consider more objectively how smoking impairs daily living, including personal disclosure of smoking-related damage through lung-function testing, deserve further research. (Aust N ZJPublic Health 1996; 20: 603-6) ITH tlhe gradual aging of the Australian population, older smokers are an important subgroup. The 1990 United States Surgeon General’s report made clear that smokers of all ages can experience substantial health benefits even a short time after stopping smoking.’ A recent review of the benefits of smoking cessation for older adults concludecl that: cessation markedly reduces the risk of coronary events and cardiac death within one year of cessation, and risk continues to decline more gradually for many years; giving up reduces the risk of death from several smoking-related cancers and bronchitis and emphysema after 10 years; within a shorter period, it reduces the prevalence of respiratory symptoms and slows the rate of decline in pulmonary function; continued smoking in later life is associated with the development and progression of several major chronic conditions, loss of mobility and poorer physical function; and former smokers appear to have higher levels of physical function and better quality of life than continuing smokers.’ These findings refute commonly held beliefs that older smokers represent a cohort of people for whom the risks of smoking should not be a public health concern.2 Older smokers represent a cohort of people in whom the smoking habit became established before its risks to health were fully appreciated and when there were few limitations on where or when a person was able to smoke. After a lifetime of smoking, and perhaps failed attempts to quit, it is possible that some older people may feel they have little to gain by giving up smoking.’ If this misconception is prevalent, efforts to assist older smokers to stop must include educational messages that reinforce the health benefits of cessation. We compared smoking behaviour and beliefs about smoking cessation among older people (aged 60 years and over) with their younger counterparts using data from a South Australian representative population sample. Correspondence to Dr Melanie Wakefield, Senior Behavioural Scientist, Behaviourdl Epidemiology Unit, South Australian Health Commission, PO Box 6, Rundle Mall, SA 5000. Fax (08) 226 6316, e-mail maw@hc2.health.bd.g0v.au Method A population survey of adults living in South Australia was conducted between October and November 1992, involving a representative, multistage, systematic, clustered area sample of persons aged 15 years and over, 75 per cent of whom lived in the metropolitan regions of Adelaide with the remainder in major country centres with a population of over 1000 p e r ~ o n sAt each selected house.~ hold, the person whose birthday was next was interviewed in his or her home by a trained interviewer, with up to six call-back visits if the selected respondent was not at home. The response rate was 72 per cent, yielding 3019 completed interviews. The data were weighted by household size, age, sex and local government area to the South Australian population. Respondents were asked their smoking status, and if they smoked, their daily cigarette consumption. Smoking rate was calculated from a weighted average of cigarettes smoked on a work and a leisure day, according to how many days were worked in the week. Stage of change was assessed using the ‘contemplation ladder’, which allowed the precontemVOL. AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1996 F 20 NO. 6 WAKEFIELD ET Al plation (point 0 on the ladder: ‘NO thought of quitting’), contemplation (points 1 to 6 on the ladder) and preparation (points 7 to 10) stages of Cessation to be identified.’ Questions related to smoking behaviour included how long after waking before the first cigarette was smoked (less than 30 minutes; more than 30 minutes), which is recommended for use as an index of nicotine dependency‘j and whether the respondent had ever tried to give up. An index of smokingrelated health knowledge was constructed by assessing the extent to which respondents believed that smoking caused or aggravated smoking-related health problems from a preset list of nine (0 to 5 correct responses coded as low health knowledge; 6 or more as high). In a similar way, an index of passive smoking awareness was calculated by asking respondents whether they believed passive smoking caused or aggravated certain conditions, from a preset list of five (0 to 3 coded as low awareness; 4 or more as high). Questions related to beliefs about the smoking habit included how difficult they perceived stopping to be (very difficult; other); how confident they were that they could stop smoking (very confident, other); the extent to which the respondents believed their smoking had affected their health (not at all; a little, moderately or very much); the likelihood that they were at personal risk of developing smoking-related illnesses in the future if they were to take up or continue smoking (not at all at risk; somewhat, moderately or very much at risk); and the likely severity of any illness caused directly from smoking (very mild or mild; serious or very serious). In addition, smokers were asked how likely it would be that they would feel better after stopping for six months (somewhat, moderately or very likely; not at all likely) and if there was a safe number of cigarettes that could be smoked in a day without it affecting health. Respondents considered to be ‘older smokers’ were aged 60 years or over. Those who were not current smokers were excluded from further analyses. Older smokers were compared with smokers aged under 60 years by means of conventional chi-square tests on 2x2 tables. Variables for which statistically significant differences emerged were entered into a logistic regression analysis, the objective of which was to identify variables that differed between the two age groups. Since level of educational attainment was related both to age and to several of the independent variables of interest, it was a potential confounder, and was therefore forced into the model.’ Those variables that were not significant were systematically removed through a backward elimination process until a model was attained that described the best-fitting joint predictors of being an older smoker. Before multivariate analyses were performed, predictor variables were examined for multicollinearity. All analyses used SPSS Version 4.1. Results Of the 3019 respondents, 653 (21.6 per cent) were aged 60 years or over. The prevalence of smoking among people aged 60 and over was 13.5 per cent (95 per cent confidence interval (CI) 10.9 to 16.2 per cent). Within the subgroup of older people, smoking prevalence was 10.0 per cent (CI 6.7 to 13.3 per cent) among those aged 70 years and over. Among those aged 60 years over, smoking prevalence was significantly lower among females (9.8 per 1 cent) than among males (18.1 per cent) (x2=8.8, df, P < 0.01). This was accounted for by a larger percentage of never-smokers among females (66.4 per 1 cent) than among males (22.7 per cent) (xp=133.9, df, P < 0.01), rather than differences in the percentage of exsmokers. There were statistically significant univariate differences between older and younger smokers (Table 1). Compared with younger smokers, a significantly greater proportion of older smokers was in the precontemplation stage of change and, consistent with this, there was a trend for more older smokers to have never tried to stop. Older smokers were less convinced of the effects on health of both active and passive smoking. Older smokers were more likely to believe that they were not personally at risk of harm now or in future because of their smoking, and to believe that their smoking had had no effect on their health. Fewer older smokers thought it was likely that they would feel more healthy if they managed to stop smoking for six months. Older smokers were more likely to believe that there was a certain Table 1 : Univariate analyses: characteristics of older smokers compared with younger smokers(%) Category % at precontemplation stage of change %who had not tried to quit %with low health awareness %with low awareness of effects of passive smoking % feeling not at all personally at risk of harm % aware of no effect on own health % expecting smoking-related illness to be mild or very mild % likely to feel better if they quit % very confident that they could quit % feeling that there is a safe level of consumption % smoking > 24 cigarettes/day % having first cigarette of day within 30 minutes of waking 604 Age group (years) 4 0 (n=727) 260 (n=88) 23.1 18.8 26.5 38.3 8.0 27.4 34.0 87.0 21.8 30.7 23.0 46.6 42.9 27.3 60.2 57.0 31.1 53.2 42.9 67.0 13.1 52.5 19.9 50.4 VOL. <0.001 0.06 <0.001 <0.001 <0.001 <0.001 0.10 <0.001 0.06 <0.001 0.53 0.51 AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1996 F 20 NO. 6 SMOKING AND OLDER AUSTRALIANS number of cigarettes that could be smoked per day without incurring health damage. There was no significant difference in the proportions who believed that illnesses caused by smoking tended to be mild. There was a rrend towards older smokers being less likely than others to be very confident that they could stop smoking, although there were no appreciable differences in the extent to which stopping was thought to be very difficult. Older smokers were more likely to believe that there was a safe number of cigarettes that could be smoked each day. However, there were no differences between older and younger smokers in the percentage who smoked 25 or more cigarettes per day or who smoked their first cigarette of the day within 30 minutes of waking. Table 2 shows the results of a logistic regression analysis that controlled for level of educational attainment, with older age group as the outcome variable (x2=88.2,5 df, P < 0.001) in describing the independent characteristics of older and younger smokers. The model suggested that, apart from having a lower educational attainment, older smokers were more likely than younger smokers to have a low knowledge of the risks of smoking, were more likely to believe that they would not be at personal risk of experiencing harmful effects of smoking in future, more likely to believe that smoking had not had any effect on their health and more likely to believe that there was a certain number of cigarettes per day that could be smoked safely. Discussion The smoking prevalence found is consistent with most recent figures for Australia8and with estimates from the IJnited States' for people aged 60 years and over. Our data showed a higher prevalence of neversmoking (66 per cent) among women than among men (23 per cent). This was an expected finding, Table 2: Logistic regression analysis: independen1 variables associated with being an older smoker (260years) 95% confidence interval Variable Odds ratio Highest educational attainment 1 .o School beyond age 15 Left before age 15 6.2 Health knowledge 3.5 to 10.9 <0.001 High Low Personally at risk of harm Somewhat or morle Not at all Effect on own health Some or more None Safe number of cigarettes/day No Ye s 1 .o 1 .o 1.4 to 4.6 1.1 to4.2 1 .o 2.0 1 .o 1.9 1.1 to 3.7 1.1 to 3.4 given the history of higher smoking uptake among men before 1960.") Although significant differences emerged in the univariate analyses, many variables were no longer statistically significant after we controlled for level of educational attainment and other variables. From the logistic regression analysis, we found that older smokers were significantly more likely to have a low knowledge scores relating to the effects of smoking on health, to perceive that they were not personally at risk from their smoking in the future, to believe that smoking had not affected their own health so far and to believe there was a daily level of cigarette consumption that was safe. Nearly one-third of older smokers perceived themselves to be personally immune to the harmful effects of smoking in future, over half thought their smoking had not affected their health so far and half thought there was a safe level of consumption. These variables were statistically significant, even with the relatively small sample size of 88 older smokers, indicating that the observed differences are robust. These results imply that older people may constitute a group of more committed smokers, who deny that the risks of smoking are personally relevant. To some extent, these may be considered logical conclusions on the part of older people, based on their own experience of four or more decades of smoking. Previous research has suggested that symptomatic older smokers may deny the effects of smoking on their health or may assume that symptoms caused by smoking, such as tiring easily or shortness of breath, may be caused instead by aging.'" Studies of self-reported health status show that, when asked to make judgments about their health without a causal attribution, those who have ever smoked perceive their health as significantly poorer than do never-smokers.''-" In particular, ever-smokers perceive themselves to be less physically active, to have less vitality, and in general, to consider themselves as less healthy. However, many may not attribute their poorer health to the effects of smoking. Efforts to improve older smokers' appreciation of the risks of smoking might need to focus on how smoking impairs daily living. Correcting misattributions about the underlying cause of symptoms commonly experienced by older smokers might be a productive strategy for motivating cessation attempts. For example, knowledge of the results of lung function testing or expired carbon monoxide measures might be especially useful and available techniques to encourage older smokers to consider the effects of smoking more objectively. Studies have found higher spontaneous rates of smoking cessation among older people who are diagnosed with serious illness, such as myocardial infarction, stroke or cancer,'"and those who develop conditions such as diabetes or hypertension.I5 While patients may be highly amenable to smoking-cessation advice at the time of diagnosis of smokingrelated illnesses, and there are benefits of cessation for some of these patients in preventing complications and disease progression,' primary prevention efforts would be more desirable. AUSTRALIAN AND NEW ZEAIAND JOURNAL O PUBLIC HEALTH 1996 VOL. 20 NO. 6 F WAKEFIELD ET AL It has been suggested that more weight should be given to emphasising the health benefits of smoking cessation for this segment of the smoking population.Y Appropriate avenues for messages about smoking cessation might be through general practitioners, who are more frequently visited by older people, during episodes of hospitalisation, and through the broadcast and print media. Some have argued that smoking represents one of the 'few remaining pleasures' for an elderly personI6 and that smoking cessation may so reduce an older person's quality of life that the costs of the reduction in risk would far exceed the benefits." However, a recent study in Canada showed smoking among elderly people to be associated with several negative quality-of-lifeoutcomes, including poorer health ratings and respiratory problems among men and women, impaired mobility, high life stress and analgesic use among males and low happiness, dissatisfaction with social relationships and selected medication use among females.18These associations were independent of the effects of marital status, education, household income and age. Given the fact that many older people have spent most of their lives as smokers, there may be a real concern that their smoking habit is irreversible, or that they lack the skills to overcome the perceived barriers to giving up, such as irritability, weight gain and overcoming cravings." Further research to explore the barriers to giving up perceived by older people may be helpful in developing appropriate resources and strategies for older smokers. While smoking prevalence is lower among older than younger adults, older adults are particularly at risk from smoking-related disease and disability because they have smoked for many more years. Indeed, smoking is a major risk factor for seven of the 14 main causes of death for older people.'9 Research has demonstrated health benefits of cessation in older people, and some studies suggest that such benefits are greater in older than younger adults, in terms of the potential numbers of deaths prevented2" and the potential for 'compression of morbidity' through reduced illness and disability." Despite this, there has been little systematic effort in Australia to focus intervention efforts on older adults, although there has recently been some public education activity in Victoria." It may well be time, given the intractable nature of adolescent smoking rates,'" to examine the potential for older people to constitute an important target group for minimising the harm to the population from tobacco. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Smoking behaviours and beliefs of older Australians

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Publisher
Wiley
Copyright
Copyright © 1996 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.1996.tb01073.x
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Abstract

Penny Kent and Lyn Roberts South Australian Smoking and Health Project, Adelaide Neville Owen Department of Human Movement Science, Deakin University, Melbourne Abstract: Reviews of the effects of smoking on health have concluded that older smokers can experience considerable health benefits from giving up smoking. In a representative population survey of people aged 15 years and over in South Australia, the percentage of people aged 60 years and over who were smokers was 13.5 per cent (95 per cent confidence interval 10.9 to 16.2 per cent). Compared with smokers aged under 60 years (n=727), older smokers (n=88)were significantly more likely: to be less convinced of the effects of smoking on health; to perceive that they were not personally at risk from their o smoking in the future; to believe that smoking had not affected their own health s far; and to believe there was a daily level of cigarette consumption that was safe. Strategies to encourage older people to consider more objectively how smoking impairs daily living, including personal disclosure of smoking-related damage through lung-function testing, deserve further research. (Aust N ZJPublic Health 1996; 20: 603-6) ITH tlhe gradual aging of the Australian population, older smokers are an important subgroup. The 1990 United States Surgeon General’s report made clear that smokers of all ages can experience substantial health benefits even a short time after stopping smoking.’ A recent review of the benefits of smoking cessation for older adults concludecl that: cessation markedly reduces the risk of coronary events and cardiac death within one year of cessation, and risk continues to decline more gradually for many years; giving up reduces the risk of death from several smoking-related cancers and bronchitis and emphysema after 10 years; within a shorter period, it reduces the prevalence of respiratory symptoms and slows the rate of decline in pulmonary function; continued smoking in later life is associated with the development and progression of several major chronic conditions, loss of mobility and poorer physical function; and former smokers appear to have higher levels of physical function and better quality of life than continuing smokers.’ These findings refute commonly held beliefs that older smokers represent a cohort of people for whom the risks of smoking should not be a public health concern.2 Older smokers represent a cohort of people in whom the smoking habit became established before its risks to health were fully appreciated and when there were few limitations on where or when a person was able to smoke. After a lifetime of smoking, and perhaps failed attempts to quit, it is possible that some older people may feel they have little to gain by giving up smoking.’ If this misconception is prevalent, efforts to assist older smokers to stop must include educational messages that reinforce the health benefits of cessation. We compared smoking behaviour and beliefs about smoking cessation among older people (aged 60 years and over) with their younger counterparts using data from a South Australian representative population sample. Correspondence to Dr Melanie Wakefield, Senior Behavioural Scientist, Behaviourdl Epidemiology Unit, South Australian Health Commission, PO Box 6, Rundle Mall, SA 5000. Fax (08) 226 6316, e-mail maw@hc2.health.bd.g0v.au Method A population survey of adults living in South Australia was conducted between October and November 1992, involving a representative, multistage, systematic, clustered area sample of persons aged 15 years and over, 75 per cent of whom lived in the metropolitan regions of Adelaide with the remainder in major country centres with a population of over 1000 p e r ~ o n sAt each selected house.~ hold, the person whose birthday was next was interviewed in his or her home by a trained interviewer, with up to six call-back visits if the selected respondent was not at home. The response rate was 72 per cent, yielding 3019 completed interviews. The data were weighted by household size, age, sex and local government area to the South Australian population. Respondents were asked their smoking status, and if they smoked, their daily cigarette consumption. Smoking rate was calculated from a weighted average of cigarettes smoked on a work and a leisure day, according to how many days were worked in the week. Stage of change was assessed using the ‘contemplation ladder’, which allowed the precontemVOL. AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1996 F 20 NO. 6 WAKEFIELD ET Al plation (point 0 on the ladder: ‘NO thought of quitting’), contemplation (points 1 to 6 on the ladder) and preparation (points 7 to 10) stages of Cessation to be identified.’ Questions related to smoking behaviour included how long after waking before the first cigarette was smoked (less than 30 minutes; more than 30 minutes), which is recommended for use as an index of nicotine dependency‘j and whether the respondent had ever tried to give up. An index of smokingrelated health knowledge was constructed by assessing the extent to which respondents believed that smoking caused or aggravated smoking-related health problems from a preset list of nine (0 to 5 correct responses coded as low health knowledge; 6 or more as high). In a similar way, an index of passive smoking awareness was calculated by asking respondents whether they believed passive smoking caused or aggravated certain conditions, from a preset list of five (0 to 3 coded as low awareness; 4 or more as high). Questions related to beliefs about the smoking habit included how difficult they perceived stopping to be (very difficult; other); how confident they were that they could stop smoking (very confident, other); the extent to which the respondents believed their smoking had affected their health (not at all; a little, moderately or very much); the likelihood that they were at personal risk of developing smoking-related illnesses in the future if they were to take up or continue smoking (not at all at risk; somewhat, moderately or very much at risk); and the likely severity of any illness caused directly from smoking (very mild or mild; serious or very serious). In addition, smokers were asked how likely it would be that they would feel better after stopping for six months (somewhat, moderately or very likely; not at all likely) and if there was a safe number of cigarettes that could be smoked in a day without it affecting health. Respondents considered to be ‘older smokers’ were aged 60 years or over. Those who were not current smokers were excluded from further analyses. Older smokers were compared with smokers aged under 60 years by means of conventional chi-square tests on 2x2 tables. Variables for which statistically significant differences emerged were entered into a logistic regression analysis, the objective of which was to identify variables that differed between the two age groups. Since level of educational attainment was related both to age and to several of the independent variables of interest, it was a potential confounder, and was therefore forced into the model.’ Those variables that were not significant were systematically removed through a backward elimination process until a model was attained that described the best-fitting joint predictors of being an older smoker. Before multivariate analyses were performed, predictor variables were examined for multicollinearity. All analyses used SPSS Version 4.1. Results Of the 3019 respondents, 653 (21.6 per cent) were aged 60 years or over. The prevalence of smoking among people aged 60 and over was 13.5 per cent (95 per cent confidence interval (CI) 10.9 to 16.2 per cent). Within the subgroup of older people, smoking prevalence was 10.0 per cent (CI 6.7 to 13.3 per cent) among those aged 70 years and over. Among those aged 60 years over, smoking prevalence was significantly lower among females (9.8 per 1 cent) than among males (18.1 per cent) (x2=8.8, df, P < 0.01). This was accounted for by a larger percentage of never-smokers among females (66.4 per 1 cent) than among males (22.7 per cent) (xp=133.9, df, P < 0.01), rather than differences in the percentage of exsmokers. There were statistically significant univariate differences between older and younger smokers (Table 1). Compared with younger smokers, a significantly greater proportion of older smokers was in the precontemplation stage of change and, consistent with this, there was a trend for more older smokers to have never tried to stop. Older smokers were less convinced of the effects on health of both active and passive smoking. Older smokers were more likely to believe that they were not personally at risk of harm now or in future because of their smoking, and to believe that their smoking had had no effect on their health. Fewer older smokers thought it was likely that they would feel more healthy if they managed to stop smoking for six months. Older smokers were more likely to believe that there was a certain Table 1 : Univariate analyses: characteristics of older smokers compared with younger smokers(%) Category % at precontemplation stage of change %who had not tried to quit %with low health awareness %with low awareness of effects of passive smoking % feeling not at all personally at risk of harm % aware of no effect on own health % expecting smoking-related illness to be mild or very mild % likely to feel better if they quit % very confident that they could quit % feeling that there is a safe level of consumption % smoking > 24 cigarettes/day % having first cigarette of day within 30 minutes of waking 604 Age group (years) 4 0 (n=727) 260 (n=88) 23.1 18.8 26.5 38.3 8.0 27.4 34.0 87.0 21.8 30.7 23.0 46.6 42.9 27.3 60.2 57.0 31.1 53.2 42.9 67.0 13.1 52.5 19.9 50.4 VOL. <0.001 0.06 <0.001 <0.001 <0.001 <0.001 0.10 <0.001 0.06 <0.001 0.53 0.51 AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1996 F 20 NO. 6 SMOKING AND OLDER AUSTRALIANS number of cigarettes that could be smoked per day without incurring health damage. There was no significant difference in the proportions who believed that illnesses caused by smoking tended to be mild. There was a rrend towards older smokers being less likely than others to be very confident that they could stop smoking, although there were no appreciable differences in the extent to which stopping was thought to be very difficult. Older smokers were more likely to believe that there was a safe number of cigarettes that could be smoked each day. However, there were no differences between older and younger smokers in the percentage who smoked 25 or more cigarettes per day or who smoked their first cigarette of the day within 30 minutes of waking. Table 2 shows the results of a logistic regression analysis that controlled for level of educational attainment, with older age group as the outcome variable (x2=88.2,5 df, P < 0.001) in describing the independent characteristics of older and younger smokers. The model suggested that, apart from having a lower educational attainment, older smokers were more likely than younger smokers to have a low knowledge of the risks of smoking, were more likely to believe that they would not be at personal risk of experiencing harmful effects of smoking in future, more likely to believe that smoking had not had any effect on their health and more likely to believe that there was a certain number of cigarettes per day that could be smoked safely. Discussion The smoking prevalence found is consistent with most recent figures for Australia8and with estimates from the IJnited States' for people aged 60 years and over. Our data showed a higher prevalence of neversmoking (66 per cent) among women than among men (23 per cent). This was an expected finding, Table 2: Logistic regression analysis: independen1 variables associated with being an older smoker (260years) 95% confidence interval Variable Odds ratio Highest educational attainment 1 .o School beyond age 15 Left before age 15 6.2 Health knowledge 3.5 to 10.9 <0.001 High Low Personally at risk of harm Somewhat or morle Not at all Effect on own health Some or more None Safe number of cigarettes/day No Ye s 1 .o 1 .o 1.4 to 4.6 1.1 to4.2 1 .o 2.0 1 .o 1.9 1.1 to 3.7 1.1 to 3.4 given the history of higher smoking uptake among men before 1960.") Although significant differences emerged in the univariate analyses, many variables were no longer statistically significant after we controlled for level of educational attainment and other variables. From the logistic regression analysis, we found that older smokers were significantly more likely to have a low knowledge scores relating to the effects of smoking on health, to perceive that they were not personally at risk from their smoking in the future, to believe that smoking had not affected their own health so far and to believe there was a daily level of cigarette consumption that was safe. Nearly one-third of older smokers perceived themselves to be personally immune to the harmful effects of smoking in future, over half thought their smoking had not affected their health so far and half thought there was a safe level of consumption. These variables were statistically significant, even with the relatively small sample size of 88 older smokers, indicating that the observed differences are robust. These results imply that older people may constitute a group of more committed smokers, who deny that the risks of smoking are personally relevant. To some extent, these may be considered logical conclusions on the part of older people, based on their own experience of four or more decades of smoking. Previous research has suggested that symptomatic older smokers may deny the effects of smoking on their health or may assume that symptoms caused by smoking, such as tiring easily or shortness of breath, may be caused instead by aging.'" Studies of self-reported health status show that, when asked to make judgments about their health without a causal attribution, those who have ever smoked perceive their health as significantly poorer than do never-smokers.''-" In particular, ever-smokers perceive themselves to be less physically active, to have less vitality, and in general, to consider themselves as less healthy. However, many may not attribute their poorer health to the effects of smoking. Efforts to improve older smokers' appreciation of the risks of smoking might need to focus on how smoking impairs daily living. Correcting misattributions about the underlying cause of symptoms commonly experienced by older smokers might be a productive strategy for motivating cessation attempts. For example, knowledge of the results of lung function testing or expired carbon monoxide measures might be especially useful and available techniques to encourage older smokers to consider the effects of smoking more objectively. Studies have found higher spontaneous rates of smoking cessation among older people who are diagnosed with serious illness, such as myocardial infarction, stroke or cancer,'"and those who develop conditions such as diabetes or hypertension.I5 While patients may be highly amenable to smoking-cessation advice at the time of diagnosis of smokingrelated illnesses, and there are benefits of cessation for some of these patients in preventing complications and disease progression,' primary prevention efforts would be more desirable. AUSTRALIAN AND NEW ZEAIAND JOURNAL O PUBLIC HEALTH 1996 VOL. 20 NO. 6 F WAKEFIELD ET AL It has been suggested that more weight should be given to emphasising the health benefits of smoking cessation for this segment of the smoking population.Y Appropriate avenues for messages about smoking cessation might be through general practitioners, who are more frequently visited by older people, during episodes of hospitalisation, and through the broadcast and print media. Some have argued that smoking represents one of the 'few remaining pleasures' for an elderly personI6 and that smoking cessation may so reduce an older person's quality of life that the costs of the reduction in risk would far exceed the benefits." However, a recent study in Canada showed smoking among elderly people to be associated with several negative quality-of-lifeoutcomes, including poorer health ratings and respiratory problems among men and women, impaired mobility, high life stress and analgesic use among males and low happiness, dissatisfaction with social relationships and selected medication use among females.18These associations were independent of the effects of marital status, education, household income and age. Given the fact that many older people have spent most of their lives as smokers, there may be a real concern that their smoking habit is irreversible, or that they lack the skills to overcome the perceived barriers to giving up, such as irritability, weight gain and overcoming cravings." Further research to explore the barriers to giving up perceived by older people may be helpful in developing appropriate resources and strategies for older smokers. While smoking prevalence is lower among older than younger adults, older adults are particularly at risk from smoking-related disease and disability because they have smoked for many more years. Indeed, smoking is a major risk factor for seven of the 14 main causes of death for older people.'9 Research has demonstrated health benefits of cessation in older people, and some studies suggest that such benefits are greater in older than younger adults, in terms of the potential numbers of deaths prevented2" and the potential for 'compression of morbidity' through reduced illness and disability." Despite this, there has been little systematic effort in Australia to focus intervention efforts on older adults, although there has recently been some public education activity in Victoria." It may well be time, given the intractable nature of adolescent smoking rates,'" to examine the potential for older people to constitute an important target group for minimising the harm to the population from tobacco.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 1996

There are no references for this article.