Lessons from Geroscience to End Smoking and Promote Healthy Aging

Smoking acts as an aging accelerant, and smokers can lose up to a decade of life expectancy to tobacco. This difference from non-smokers has long been reflected in the life insurance industry’s higher premiums for smokers. However, as well as reducing risks of chronic disease and mortality, quitting smoking or switching to non-combustible tobacco harm reduction (THR) nicotine products significantly improve both longevity and healthy aging outcomes. The biology of aging, and how knowledge might extend health span (the healthy, functional years of life) through interventions that increase resilience, is being assessed in the interdisciplinary field of geroscience. Research employing biomarkers of aging (such as epigenetic clocks and telomere length) indicates rejuvenation effects when smokers quit or switch to THR. Nevertheless, the use of THR as a gerotherapeutic option is not well understood. Aligning THR, and specifically the use of “clean” non-combustible nicotine products, with geroscience goals by treating smoking not only as a cause of disease but as a modifiable driver of aging, presents new opportunities for public health. For example, aging outcomes, such as Parkinson’s disease, cognitive aging and physical function, could be integrated into smoking cessation trials using THR and provide new ways to measure benefits. Concepts, such as intrinsic capacity—encompassing an individual’s physical and cognitive functional ability—already offer practical metrics. Findings could be articulated in terms of achievable goals that might resonate anew with the public and policymakers and encourage THR uptake. This article applies insights from geroscience to tobacco control strategies to illustrate how “success” could be broadened beyond diseases avoided and deaths averted to encompass extended lifespan with improved health outcomes.