BACKGROUND-AIM:
Combustible tobacco remains a major health concern in the European Union (EU), while emerging nicotine-containing products such as e-cigarettes and heated tobacco products (HTPs) have become increasingly popular. Yet most evidence focuses on younger populations, with limited attention to older adults, who face higher risks of tobacco-related disease and reduced life expectancy and quality of life with continued use. Given the EU’s ageing population, evidence on tobacco and nicotine use in later life is needed to inform policy and practice. This study examines prevalence and sociodemographic correlates of tobacco and nicotine use among adults aged ≥65 years in the EU.

METHODS:
We analysed data for 7651 participants aged ≥65 years from Special Eurobarometer 99.3 (May–June 2023) collected across 27 EU Member States (MS). We estimated the weighted prevalence of current use (at least weekly) of the following: combustible tobacco (boxed cigarettes, hand-rolled cigarettes, cigarillos, cigars, pipe tobacco, or waterpipe tobacco); non-combustible nicotine-containing products (e-cigarettes, HTPs, nicotine pouches, oral tobacco, chewing tobacco, or nasal tobacco); any nicotine-containing product; and dual use. Multilevel Poisson regression models examined associations between sociodemographic factors and tobacco and nicotine use.

RESULTS:
Among adults aged ≥65 years in the EU, 12.0% (95% confidence interval [CI]: 10.9–13.2) reported current daily or weekly use of combustible tobacco and 12.6% (11.5–13.9) reported using any nicotine-containing product. Use of non-combustible nicotine-containing products (1.2%, 0.8–1.6) and dual use (0.5%, 0.3–0.8) were low overall. However, the prevalence of use varied significantly across the 27 EU MS. Combustible tobacco use ranged from 8.0% (5.8–10.9) in Sweden to 23.2% (18.3–29.0) in Greece. For non-combustible products, prevalence was highest in Sweden (7.7%, 5.6–10.5), and six MS reported no current use. Women and increasing age were associated with a lower likelihood of tobacco or nicotine-containing product use. Reporting financial difficulties was associated with a higher likelihood of use—combustible products (Prevalence Ratio [PR]=1.24, 95% CI: 1.05–1.45), any nicotine-containing product (PR=1.19, 1.03–1.38), and dual use (PR=3.04, 1.45–6.36). No consistent association was observed for education overall; however, those who completed education after age 20 were more likely to be dual users than those who finished at ages 0–15 years (PR=3.61, 1.15–11.35).

CONCLUSIONS:
Combustible tobacco remains the predominant form of nicotine use among older adults in the EU, with minimal uptake of emerging products. Marked cross-country variation likely reflects differences in legislation, enforcement and socio-cultural context. To support the EU’s healthy ageing agenda, EU-wide efforts should also prioritise older adults by widening access to age-appropriate cessation support and addressing affordability.