A Qualitative Study Identifying Motivators, Facilitators, and Barriers to Tobacco Cessation in Older Adults

  • Lana M. Brown Associate Nurse Executive for Research Central Arkansas Veterans Healthcare System
Keywords: Tobacco, Tobacco Cessation, Qualitative Research, Transtheoretical Model (TTM), Older Adults


Background: Tobacco use is the single largest preventable cause of premature death and disease in the world and in the United States and is associated with diseases of nearly every organ system. Tobacco cessation is considered the single most important factor to improve the health of older adults who use tobacco. However, minimal research has focused on the process of tobacco cessation or factors influencing this process.

Purpose:  This qualitative study aimed to identify motivators, facilitators, and barriers to tobacco cessation and prolonged cessation in older adults aged 50 years and older.

Design and Methods: This qualitative research study explored tobacco cessation in community dwelling older adults after receiving Institutional Review Board approval. The Transtheoretical Model of Behavior Change was the conceptual framework used to guide this study. Snowball sampling was used to recruit 20 older adults who had ceased using tobacco products for one year or more and remained tobacco free. Semi-structured audio-recorded interviews were conducted in each participant’s home.  Data were analyzed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics.

Results: Participants were from three southern states and included 11 males and nine females with 18 Caucasian and two African American. The average age of participants at the time of the interview was 71.5 years, and the average quitting age was 60.5 years. Four global themes related to tobacco cessation in older adults emerged from the analysis: (a) motivators, (b) facilitators, (c) barriers, and (d) life after tobacco. These older adults attribute their successful tobacco cessation to self-motivation, accountability to self and others, and finding replacements for tobacco. Barriers to tobacco cessation included tobacco triggers/temptations and addiction/withdrawal symptoms. Participants described themselves as proud, strong, and independent after quitting.

Conclusion: Information gained from older adults who have ceased using tobacco products can be used to develop tobacco cessation interventions that health care providers can use to assist older patients who desire to quit.

Author Biography

Lana M. Brown, Associate Nurse Executive for Research Central Arkansas Veterans Healthcare System

College of Nursing

Clinical Assistant Professor


Andrews, J. O., Heath, J., & Graham-Garcia, J. (2004). Management of tobacco dependence in older adults: Using evidence-based strategies. Journal of Gerontological Nursing, 30(12), 13-24. Retrieved from http://toxnet.nlm.nih.gov/cgi-bin/sis/search/r?dbs+hsdb:@term+@rn+54-11-5 pmid:15624692

Bernard, H. R., & Ryan, G. W. (2010). Analyzing Qualitative Data: Systematic Approaches. Thousand Sands. CA: SAGE Publications, Inc.

Boyd, N. R. (1996). Smoking cessation: A four-step plan to help older patients quit. Geriatrics, 51(11), 52-57. Retrieved from http://www.nlm.nih.gov/medlineplus/quittingsmoking.html pmid:8918483

Burton, L. C., Paglia, M. J., German, P. S., Shapiro, S., Damiano, A. M., Steinwachs, D., & Kasper, J. (1995). The effect among older persons of a general preventive visit on three health behaviors: Smoking, excessive alcohol drinking, and sedentary lifestyle. Preventative Medicine, 24(5), 492-497. Retrieved from http://www.scholaruniverse.com/ncbi-linkout?id=8524724 pmid:8524724

Cataldo, J. (2007). Clinical implications of smoking and aging: Breaking through the barriers. Journal of Gerontological Nursing, 33(8), 30-34. Retrieved from http://www.nlm.nih.gov/medlineplus/quittingsmoking.html pmid:17718376

Clair, C., Rigotti, N. A., Porneala, B., Fox, C. S., D’Agostino, R. B., Pencina, M. J., & Meigs, J. B. (2013). Association of smoking cessation and weight change with cardiovascular disease among adults with and without diabetes. Journal of the American Medical Association, 309(10), 1014-1021. Retrieved from http://europepmc.org/abstract/MED/23483176 pmid:23483176 doi:10.1001/jama.2013.1644

DiFranza, J. R., Wellman, R. J., Savageau, J. A., Beccia, A., Sanouri, W. W., Ursprung, S. A., & McMillen, R. (2013). What aspect of dependence does the Fagerström Test for Nicotine Dependence measure? ISRN Addiction, 2013, 1-8.

Flatt, J. D., Agimi, Y., & Albert, S. M. (2012). Homophily and health behavior in social networks of older adults. Family Community Health, 35(4), 312-321. doi: 10.1097/FCH.0b013e3182666650

Filozof, C., Fernández Pinilla, M. C., & Fernández-Cruz, A. (2004). Smoking cessation and weight gain. The International Association for the Study of Obesity, 5(2), 95-103.

Fiore, M. C., & Baker, T. B. (2013). Should clinicians encourage smoking cessation for every patient who smokes? Journal of the American Medical Association, 309(10), 1032-1033. doi:10.1001/jama.2013.1793.

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(3), 463-470. doi:10.1080/14622200801901922

Huber, G. L., & Mahajan, V. K. (2008). Successful Smoking Cessation. Disease Management & Health Outcomes, 16(5), 335-343.

Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., McAfee, T., ... Peto, R. (2013). 21st-Century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, 368(4), 341-350. doi:10.1056/NEJMsa1211128

Jónsdóttir, R., & Jónsdóttir, H. (2011). "This is your own doing"--An addiction narrative of smoking relapse in women with COPD. Nordic Journal of Nursing Research & Clinical Studies, 31(1), 25-28.wartawan hari ini

Kerr, S., Watson, H., Tolson, D., Lough, M., & Brown, M. (2006). Smoking after the age of 65 years: A qualitative exploration of older current and former smokers' views on smoking, stopping smoking, and smoking cessation resources and services. Health and Social Care in the Community, 14(6), 572-582. doi: 10.1111/j.1365-2524.2006.00659.x

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, Third Quarter, 177-186. doi: 10.1111/j.1741-6787.2011.00219.x

Kleykamp, B. A., & Heishman, S. J. (2011). The older smoker. The Journal of the American Medical Association, 306(8), 866-867. doi:10.1001/jama.2011.1221

Kviz, F. J., Crititendon, K. S., Clark, M. A., Madura, K. J., & Warnecke, R. B. (1994). Buddy support among older smokers in a smoking cessation program. Journal of Aging Health, 6(2), 229-254. doi: 10.1177/089826439400600206

Lundqvist, G., Weinehall, L., & Åhman, A. (2006). Attitudes and barriers towards smoking cessation among middle aged and elderly women: A qualitative study in family practice. Internet Journal of Health, 5(2), 8p. doi: 10.1111/j.1365-2702.2007.01701.x

Medbø, A., Melbye, H., & Rudebeck, C. E. (2011). "I did not intend to stop. I just could not stand cigarettes any more." A qualitative interview study of smoking cessation among the elderly. Bmc Family Practice, 12(42), 1-10. doi: 10.1186/1471-2296-12-42

Miller, N., Friedan, T. R., Liu, S. Y., Matte, T. D., Mostashari, F., Deitcher, D. R., Cummings, K. M., ... Bassett, M. T. (2005). Effectiveness of a large-scale distribution programme of free nicotine patches: A prospective evaluation. Lancet, 365(9474), 1849-1854. doi: 10.1016/S0140-6736(05)66615-9

Morgan, G. D., Noll, E. L., Orleans, C. T., Rimer, B. K., Amfoh, K., & Bonney, G. (1996). Reaching midlife and older smokers: Tailored interventions for routine medical care. Preventative Medicine, 25(3), 346-354. doi: 10.1006/pmed.1996.0065

Murthy, P., & Subodh, B. N. (2010). Current developments in behavioral interventions for tobacco cessation. Current Opinion in Psychiatry, 23, 151-156. doi: 10.1097/YCO.0b013e328336653f

Orleans, C. T., Resch, N., Noli, E., Keintz, M. K., Rimer, B. K., Brown, T. V., & Snedden, T. M. (1994). Use of transdermal nicotine in a state-level prescription plan for the elderly: A first look at 'real-world' patch users. Journal of American Medical Association, 271(8), 601-607. doi: 10.1001/jama.1994.03510320041027

Ossip-Klein, D. J., Carosella, A. M., & Krusch, D. A. (1997). Self-help interventions for older smokers. Tobacco Control, 6, 199-193. doi: 10.1136/tc.6.3.188

Prochaska, J. O. (2008). Multiple health behavior research represents the future of preventative medicine. Preventative Medicine, 46, 281-285. doi:10.1016/j.ypmed.2008.02.001

Prochaska, J. O., Johnson, S., & Lee, P. (2009). The Transtheoretical Model of behavior change. In The handbook of health behavior change (3rd ed., pp. 59-83). New York: Springer Publishing.

Prochaska, J. O., Wright, J. A., & Velicer, W. F. (2008). Evaluating theories of health behavior change: A hierarchy of criteria applied to the transtheoretical model. Applied Psychology, 57(4), 561-588. doi: 10.1111/j.1464-0597.2008.00345.x

Riesco Miranda, J. A., Jimenez Ruiz, C. A., & Serrano Rebollo, J. C. (2013). Smoking cessation: Update. Clinical Pulmonary Medicine, 20(3), 129-136. doi: 10.1097/CPM.0b013e31828fda4c

Rimer, B. K., & Orleans, C. T. (1994). Tailoring smoking cessation for older adults. Cancer, 74, 2051-2054. doi: 10.1002/1097-0142(19941001)74:7+<2051::AID-CNCR2820741711>3.0.CO;2-4

Rimer, B. K., Orleans, C. T., Fleisher, L., Cristinzio, S., Resch, N., Telepchak, J., & Keintz, M. K. (1994). Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers. Health Education Research, 9(1), 69-84. doi: 10.1093/her/9.1.69

Schofield, I., Kerr, S., & Tolson, D. (2007). An exploration of the smoking-related health beliefs of older people with chronic obstructive pulmonary disease. Journal of Clinical Nursing, 16(9), 1726-1735. doi: 10.1111/j.1365-2702.2007.01701.x

Tait, R., Hulse, G., Waterreus, A., Flicker, L., Lautenschlager, N., Jamrozik, K., & Almeida, O.P. (2007). Effectiveness of a smoking cessation intervention in older adults. Addiction, 102(1), 148-155. doi:10.1111/j.1360-0446.2006.01647x

The Ethnograph 6.0. (2014). Retrieved from www.qualisresearch.com/features.htm

U.S. Department of Health & Human Services. [USDHHS (2008)]. Treating tobacco use and dependence: Clinical practice guidelines, 2008 update. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.

U.S. Department of Health & Human Services. [USDHHS (2014)]. The health consequences of smoking-50 years of progress: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.

Vetter, N. J., & Ford, D. (1990). Smoking prevention among people aged 60 and over: A randomized control trial. Age Ageing, 19(3), 164-168. doi: 10.1093/ageing/19.3.164

Warner, K. E., & Mendez, D. (2010). Tobacco control policy in developed countries: Yesterday, today, and tomorrow. Nicotine & Tobacco Research, 12(9), 876-887. doi:10.1093/ntr/ntq125

World Health Organization. [WHO (2014)]. Tobacco free initiative (TFI). Retrieved from World Health Organization Web site: www.who.int/tobacco/economics/en/

How to Cite
Brown, L. M. (2015). A Qualitative Study Identifying Motivators, Facilitators, and Barriers to Tobacco Cessation in Older Adults. International Journal of Nursing, 4(1), 22-33. Retrieved from https://ijnonline.com/index.php/ijn/article/view/187
Medical Surgical Nursing