Although smoking has been shown to be associated with excess morbidity and mortality, most studies have focused on young and middle-aged rather than elderly smokers. We examined the demographic characteristics and physical and psychological health of elderly cigarette smokers in four population-based studies (N = 3,673, 3,811, 2,811, and 4,165) of persons 65 years of age and older. Although there was substantial geographic variation in the percentages of smokers, the demographic and health characteristics of smokers were similar across the sites. Most women had never smoked, but most men were former or current smokers. The percentage of never smokers was highest in the "oldest old." Among the elderly ever smokers, men were more likely to have quit than women, and the relative percentage of former smokers increased with age. Current smokers were generally more likely to consume alcohol than never smokers. In this age group, cigarette smoking was typically associated with higher rates of physical disease and symptoms, poorer self-perceived health status, and higher levels of depressive symptoms. Based on these four large geographically diverse population surveys, cigarette smoking remains an important health burden and public health challenge among the elderly.