The Prevalence and Associated Factors of Smoking and Smoking-Cessation in Iranian Older Adults: Ardakan Cohort Study on Aging (ACSA)

OBJECTIVES: This study aimed to assess the prevalence of smoking, exposure to secondhand smoke, former smoking, and associated factors among older adults. METHODS: Using data from the cross-sectional phase of the Ardakan Cohort Study on Aging (ACSA), self-reported information on smoking habits, secondhand smoke exposure, and childhood exposure to smoke was analyzed. Logistic regression was employed to evaluate factors influencing being a former smoker, while multinomial logistic regression compared nonsmokers, former smokers, and current smokers. RESULTS: A total of 4,981 individuals participated in the study, revealing that 22.23% of male participants were former smokers, 28.29% were current smokers, while only 0.19% of females were former smokers, and 0.08% were current smokers. The majority of smokers started smoking before the age of 18, with an average pack year of 26.27 and a smoking duration of 30.37 years (95% CI: 29.83 to 31.59). Exposure to secondhand smoke in homes was reported by 30.41% of women and 10.87% of men, while childhood exposure to cigarette smoke was reported by 30.37% of women and 43.29% of men. Smoking status was found to be associated with age, education, BMI, hypertension, hyperlipidemia, neurological disorders, depressive symptoms, and pack year history. CONCLUSION: The study highlights a high prevalence of both first- and secondhand smoking in the elderly population of Iran, emphasizing the need for targeted interventions. These findings may inform age- and context-appropriate public health strategies targeting older adults, particularly in regions where smoking remains socially embedded and cessation support is limited.