The adoption of tobacco dependence treatment by rehabilitation clinicians

Estimates of National Health Care Expenditures Associated With Disability

We estimated adult national health care expenditures associated with disability by type of care and payer. These estimates represent the “additional” health care expenditures associated with disability over and above any non-disability-related health care expenditures. Multivariate analyses were performed using the Medical Expenditure Panel Survey, and supplemented with administrative data. Total national disability-associated health care expenditures (DAHE) were $397.9 billion in 2006, representing 26.7 percent of national health spending. Expenditures for people in institutions, such as nursing facilities, were the largest category of DAHE. In terms of source of payment, Medicaid DAHE were the highest at $161.1 billion, followed by Medicare DAHE with $119.0 billion. Together, the Medicare and Medicaid programs incurred 70.4 percent of total health care dollars associated with disability. Policy makers should consider initiatives that will help to prevent or delay disability and to improve the organization and delivery of services to people with disabilities.

Smoking rates and smoking cessation among individuals with multiple sclerosis

PURPOSE

Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

METHOD

Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

RESULTS

Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 - 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

CONCLUSIONS

Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.

Disparities in smoking behaviors among those with and without disabilities from 2001 to 2005

OBJECTIVES

Past research has suggested smoking disparities among individuals with disabling conditions. We contrasted smoking behaviors of those with and without disabilities from 2001 to 2005.

DESIGN

Descriptive correlational study.

SAMPLE

Telephone interviews were conducted in all states with noninstitutionalized adults. Half were female; most were Anglo (70.5%) and had at least a high school education (90%). Their average age was 45 years. Approximately 19% of the sample reported being disabled.

MEASUREMENT

We analyzed 4 years of data from the population-based Behavioral Risk Factor Surveillance System.

RESULTS

While individuals with disabilities were more likely to report ever having smoked than nondisabled respondents, current smoking behaviors were more similar in the 2 groups, and the difference was not statistically significant when demographic factors were included in the model. Smoking behavior decreased somewhat for nondisabled persons between 2001 and 2005, but remained fairly constant for those with disabilities. However, those with disabilities were more likely than those without disabilities to have attempted to quit smoking in all years.

CONCLUSIONS

Findings underscore the importance of smoking cessation programs tailored to people with disabilities. The role of the public health nurse in addressing smoking cessation at the individual, system, and community level is discussed.