Cigarette Smoking Among Adults With Mobility Impairments: A US Population-Based Survey

Objectives. Smokers with mobility impairments have greater health risks than the general population. We report the prevalence of cigarette smoking and quit attempts among people with mobility impairments.Methods. We conducted an analysis of 13 308 adults (aged 21–85 years) with mobility impairments (special ambulatory equipment and difficulty walking 0.25 miles without equipment) responding to the National Health Interview Survey (2011).Results. Among 21- to 44-year-old adults with mobility impairments, 39.2% were smokers, compared with only 21.5% of adults without mobility impairments (odds ratio [OR] = 1.64; 95% confidence interval [CI] = 1.07, 2.52). Among 45- to 64-year-old adults with mobility impairments, 31.2% were smokers versus 20.7% without mobility impairments (OR = 1.35; 95% CI = 1.09, 1.68). Women aged 21 to 44 years with mobility impairments had the highest smoking prevalence (45.9%), exceeding same-aged women without mobility impairments(18.9%; OR = 2.56; 95% CI = 1.32, 4.97). Men with mobility impairments had greater smoking prevalence (24.1%) than women with mobility impairments (15.1%; P < .01). Smokers with mobility impairments were less likely to attempt quitting (19.9%) than smokers without mobility impairments (27.3%; P < .01).Conclusions. Smokers with mobility impairments should be targeted for cessation, particularly those who are younger and female.The prevalence of cigarette smoking has reached an asymptote: 19.0% of US adults are smokers, which is not significantly different from the smoking prevalence in 2004 (20.9%).1,2 A reason for this stagnancy may be the high smoking rates within underserved populations, coupled with lack of targeting underserved smokers for cessation treatment.3 Smokers with physical disabilities are underserved, as they are less likely to receive smoking cessation counseling4 and less likely to use evidenced based treatments.5 Furthermore, smokers with physical disabilities encounter numerous barriers to treatment engagement and attendance, such as lack of transportation, architectural access issues, pain, fatigue, energy fluctuations, and procedures of daily care.6–9 Smokers with physical disabilities also have greater risk factors for smoking, such as greater levels of depression and stress, and low income.10–14 Continued smoking exacerbates physical disabilities15–17 and causes or contributes to many secondary conditions including respiratory and circulatory difficulties, muscle weakness, delayed wound healing, worsening arthritis, and osteoporosis.18–22People with physical disabilities constitute 16.2% of the US population,14 and the majority of the population will experience physical disability at during their lifetime.23 Yet the prevalence of smoking among people with physical disabilities is unknown. Previous studies report on smoking prevalence for people with disabilities by collapsing across several types of disabilities (psychiatric, sensory and physical disabilities)2,10,24 rather than reporting smoking prevalence within each type. This has led to a wide range of smoking prevalence rates (24%–43%), depending upon which disability groups were included.The smoking rate among people with mobility impairments, a subpopulation of people with physical disabilities, is unknown. Mobility impairments and use of assistive devices are highly associated with reduced quality of life, development of secondary conditions, and depression,4,11,13,18,21,25 factors known to impede quitting smoking.26–28 Therefore, smoking prevalence might be greater among people with mobility limitations who use an assistive device. Brawarsky et al.29 used the 1996–1999 Massachusetts Behavioral Risk Factor Surveillance and found a 26.9% smoking prevalence among people with orthopedic problems, but their study used a heterogeneous sample including people with back or neck problems as well as people with mobility problems. In addition to being outdated and state specific, their study combines people needing ambulatory assistance with those who do not. Two other studies assessed smoking prevalence among different disability subtypes using national data from The National Health Interview Survey (NHIS): one measured smoking prevalence among people with movement difficulties (including fingers and hands),24 and one measured smoking prevalence among people with mobility limitations.30 Both studies report data more than 10 years old, and neither study reports on smoking cessation behaviors, or whether an assistive device was used.The current study uses a national sample to examine smoking prevalence and quit attempts among people with mobility impairments who use an assistive ambulatory device, compared with people without mobility impairments. We define “mobility impairments” as the use of special ambulatory equipment (e.g., cane, wheelchair, or leg braces) and difficulty walking a quarter mile without the use of special equipment. We do not propose mobility impairments as a proxy for physical disability. Rather, we believe that people with mobility impairments are an important underserved subpopulation among those with physical disabilities. Furthermore, we do not propose that people with mobility impairments are particularly underserved compared with other people with disabilities, but rather that those with mobility impairments are clearly underserved compared with the general population. Because physical disability (including mobility impairment) increases with age4,14 and smoking prevalence decreases with age,2 we also examined smoking prevalence across 3 different age groups between people with and without mobility impairments. We also explored gender differences in smoking prevalence for men and women with mobility impairments.