A systematic review of tobacco use among adolescents with physical disabilities

Tobacco and E-Product Use by US Adults With Disabilities

Importance

Research on cumulative disabilities and tobacco use in the current tobacco landscape is lacking.

Objective

To examine prevalence of tobacco use across cumulative disabilities within and across years among US adults.

Design, Setting, and Participants

Representative cross-sectional surveys of the US adult (aged ≥18 years) civilian, noninstitutionalized population from the Population Assessment of Tobacco and Health (PATH) Study were compared across 2013 to 2014 (wave 1), 2016 to 2018 (wave 4), and 2022 to 2023 (wave 7). Age-adjusted estimates and change scores were compared using design-based significance tests. Data were analyzed from November 2023 and April 2024.

Main Outcomes and Measures

Past 30-day use of tobacco (cigarette, electronic nicotine [e-product], traditional cigar, filtered cigar, cigarillo, pipe, hookah, and smokeless products); disability types (mobility, self-care, independent living, cognitive, hearing, and vision) summed to generate a 4-level cumulative disability measure (0, 1, 2, or ≥3).

Results

In 2013 to 2014, among 32 314 participants at wave 1, 3110 participants were 65 years or older (18.2%), 15 993 (51.9%) were female, 5536 (15.2%) were Hispanic, 4496 (11.2%) were non-Hispanic Black, 19 295 (66.0%) were non-Hispanic White, and 2428 (7.5%) were another non-Hispanic race. A total of 32 314 adults were included in 2013 to 2014, 33 638 in 2016 to 2018, and 30 681 in 2022 to 2023. In 2013 to 2014, any tobacco use prevalence for those with no disabilities was 25.4% (95% CI, 24.7% to 26.1%), while prevalence was 40.2% (95% CI, 38.6% to 41.8%), 48.9% (95% CI, 45.4% to 52.5%), and 51.8% (95% CI, 48.6% to 55.0%) for those with 1, 2, and 3 or more disabilities, respectively. Any tobacco, cigarette, e-product, cigarillo, filtered cigar, and pipe use were consistently higher among those with multiple disabilities compared with those with 0 or 1 disability. Prevalence was highest among those with 3 or more disabilities for all products. Tobacco use declined over time, except e-product use increased. However, not all declines in prevalence between 2013 to 2014 and 2022 to 2023 were significant among those with 3 or more disabilities. The declines for those who used any tobacco (-4.6%; 95% CI, -8.7% to -0.6%) and cigarettes (-8.9%; 95% CI, -12.7% to -5.1%) were small, and increases in e-product use were large (4.6%; 95% CI, 1.0% to 8.3%) for those with 3 or more disabilities compared with other groups.

Conclusions and Relevance

In this survey study, disparities in tobacco use existed across cumulative disabilities. Despite declines in tobacco use over time, differences in use across cumulative disabilities persisted or worsened, especially among those with 3 or more disabilities. Targeted prevention, screening, and cessation efforts inclusive of multiple products are needed.

Patterns of Alcohol, Marijuana, and Tobacco Use Among U.S. Adolescents and Young Adults by Disability Status: 2015-2019

PURPOSE

To estimate the national prevalence of tobacco, marijuana, and alcohol use among U.S. adolescents (age 12-17) and young adults (aged 18-25; adolescents and young adults [AYAs]) with a disability and examine associations between disability and substance use from 2015 to 2019.

METHODS

Data from the 2015-2019 National Survey on Drug Use and Health were used to estimate the prevalence of tobacco, marijuana, and alcohol use among AYAs with disabilities. Modified Poisson regression models evaluated linear time trends in past-month substance use and estimated adjusted prevalence ratios (aPRs) for past-month cigarette, any tobacco, alcohol, and marijuana use.

RESULTS

Adolescents with any disability had a higher prevalence of past-month cigarette (aPR = 1.87; 95% CI 1.67-2.09), alcohol (aPR = 1.21; 95% CI 1.11-1.31), and marijuana use (aPR = 1.47; 95% CI 1.36-1.60) compared to those without disabilities. Cigarette smoking among adolescents decreased over this time period; however, the decline among adolescents without a disability was greater than those with any disability. Young adults with any disability had a higher prevalence of past-month cigarette (aPR = 1.42; 95% CI 1.35-1.48) and marijuana use (aPR = 1.39; 95% CI 1.34-1.45), but a lower prevalence of past-month alcohol use (aPR = 0.93; 95% CI 0.90-0.95) than those without disabilities. Alcohol use remained constant among young adults with any disability but decreased for those without disabilities.

DISCUSSION

Population-level disparities in cigarette and marijuana use exist in AYAs with disabilities. Future studies should identify strategies tailored to AYAs with disabilities to encourage smoking cessation and prevent cannabis use disorder.

Tobacco Use in Adolescents With Disabilities: A Literature Review

The use of tobacco products by adolescents has greatly increased in recent years. Adolescents with disabilities have demonstrated higher instances of e-cigarette and tobacco use in relation to their peers without disabilities. Repercussions for e-cigarette and tobacco use increase negative physical and health implications and financial which ultimately will further the gap for individuals with disabilities over time. It is argued that adolescents with disabilities are more susceptible to begin using tobacco and remain using tobacco which can lead to further use of addictive substances. In this paper, the researcher explained the use of tobacco within the adolescent population, specifically for individuals with disabilities, the impact of tobacco use for individuals with disabilities, reviewed previous studies on tobacco use for adolescents with disabilities, points to the need for educational policy reform, and stated certain recommendations for mitigating tobacco use in adolescents with disabilities, which may result in positive future outcomes. The literature review indicated that the targeted interventions in schools or peer groups reduces tobacco use in adolescents with disabilities.

Cardiovascular risk profiles clusters among children and adolescents with disabilities

BACKGROUND

Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents' profiles clusters with and without disabilities.

METHODS

Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11-19 years old school-aged.

RESULTS

The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups.

CONCLUSION

This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

Disparities in Tobacco Use by Disability and Type: Findings From the 2019 National Health Interview Survey

INTRODUCTION

People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use.

METHODS

Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type.

RESULTS

Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95).

CONCLUSIONS

People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities.

E-cigarette disparities: Who are the targets?

The tobacco industry has a long history of promoting health disparities especially through targeted marketing campaigns. The disparities perpetuated by e-cigarettes are just becoming apparent. This article will focus on disparities in e-cigarette usage within the following categories of youth: racial or ethnic groups, sexual and gender minoritized individuals, adolescents with asthma, teens with disabilities, and those coping with mental health stresses. Millions of youth are still using e-cigarettes, and e-cigarette use is disproportionately impacting White youth, youth who identify at lesbian, gay and transgender, and youth with disabilities. In addition, this article highlights the timeline of key tobacco regulations and recommended actions to curb the e-cigarette epidemic.

Disparities in E-Cigarette and Tobacco Use Among Adolescents With Disabilities

INTRODUCTION

In 2019, nearly 30% of US high-school students reported current (past 30 day) e-cigarette use. Adolescents with disabilities are consistently more likely to smoke cigarettes compared with their nondisabled peers, yet little is known about their use of other forms of tobacco, including e-cigarettes. We compared the prevalence of tobacco use (e-cigarettes, cigarettes, little cigars, large cigars, hookahs, and smokeless tobacco) among high school students with at least 1 disability to those without disability.

METHODS

Data were from the 2015 and 2017 Oregon Healthy Teens survey, a statewide representative sample of 11th-grade students. We estimated the prevalence of current (past 30 day) tobacco use by product type and disability status (yes or no). We used multivariable Poisson regression to estimate prevalence ratios measuring the association between disability status and current tobacco use, by product: 1) combustible products only, 2) e-cigarettes only, and 3) dual use of combustibles and e-cigarettes.

RESULTS

Students with disabilities were more likely to use a variety of tobacco products compared with their nondisabled peers, including cigarettes (12.3% vs 5.4%), little cigars (7.0% vs 5.4%), hookahs (6.2% vs 3.8%), and e-cigarettes (18.3% vs 12.3%). In adjusted models, students with a disability were more likely to report using combustibles only (adjusted prevalence ratio [aPR], 1.55; 95% CI, 1.31-1.84), e-cigarettes only (aPR, 1.36; 95% CI, 1.16-1.59), or dual use (aPR, 1.52; 95% CI, 1.29-1.80) compared with nondisabled students.

CONCLUSION

Effective tobacco control programs should target populations with the greatest burden of tobacco use. Results suggest that tobacco prevention and reduction efforts should explicitly include adolescents with disabilities and employ accommodations that support their participation in program activities.

Disability and the impact of need for periodontal care on quality of life: A cross-sectional study

Objective

The need for periodontal care may negatively impact daily life. We compared the need for periodontal care and its impact on daily life between disabled and healthy adults in the Eastern Province, Saudi Arabia.

Methods

In this cross-sectional study of 819 adults, a questionnaire was used to assess personal background factors; the impact of periodontitis on pain, avoiding foods, embarrassment, sleeplessness, work absence, and discontinuing daily activities; and risk factors (smoking, diabetes, toothbrushing, insurance, professional tooth cleaning, and dental visits). The outcome was clinically assessed need for periodontal care impacting daily life. The relationship between the outcome and risk factors adjusted for personal background and disability was assessed using ordinal regression.

Results

Healthy and disabled persons had a high need for periodontal care (66.8%). Current smokers had a higher likelihood and health-insured persons had a lower likelihood of need for periodontal care impacting daily life regardless of whether disability was considered.

Conclusions

Most adults needed periodontal care, and disabled persons experienced a greater impact on life. Current smokers and uninsured persons were more likely to need periodontal care impacting daily life. Our findings are important for the prevention of periodontitis through tobacco cessation and extending insurance coverage.