Around 1 in 7 of US adults who currently smoke may have some degree of disability, suggests the first study of its kind published online in the journal Tobacco Control.
And the prevalence of disability and/or some degree of functional difficulty is twice as high among those who continue to puff away as it is among those who have never smoked, the data analysis indicates.
All in all, the figures suggest that 40% of the estimated 25 million adults who currently smoke experience some level of functional difficulty, estimate the researchers.
In 2019, smoking was the third leading risk factor for disability in the United States. But relatively little is known about the prevalence, degree, and type of functional difficulty associated with smoking, say the researchers.
To explore this further, they analysed data for 150,220 people from the National Health Interview Survey (NHIS) for the period 2019 to 2023 inclusive.
Participants were grouped according to whether they currently, formerly, or had never smoked. And the Washington Group–Short Set (WG-SS) was used to measure the degree of functional difficulty in 6 core areas: vision (even when wearing glasses); hearing (even with a hearing aid); mobility (walking or climbing steps); communication (understanding or being understood); cognition (memory and concentration); self-care (washing and dressing).
Participants were considered to have a disability if they reported having "a lot of difficulty" or "cannot do at all" in 1 or more of these 6 core areas. Those who reported "some difficulty" in at least 1 core area were also included in the estimates.
Between 2019 and 2023, 1 in 7 (14%) of those who currently smoked reported a disability compared with 12.5% of adults who formerly smoked and 7% of those who had never smoked.
The most common disabilities among those who currently, formerly, or never smoked were, respectively, mobility (8%, 8%, and 4%) and cognitive issues (4.5%, 3%, and 2%).
Among adults who currently smoked, more than half (54%) reported "some", "a lot of", or "cannot do at all" for at least 1 disability type. And the prevalence of vision, hearing, mobility and cognitive disabilities among those who currently smoked was double that of those who had never smoked.
The estimates for disability were significantly higher for those who currently smoked than they were among those who had never smoked with the exception of self-care, and they were also significantly higher for adults who formerly smoked with the exception of communication.
Stratification of disability prevalence by age, sex, race/ethnicity, and educational level among adults who currently smoked showed that it was 16.5% among women and 12% among men and ranged from just over 21.5% among the over 65s to 9% among 25–44 year olds.
Similarly, the prevalence of disability ranged from 19% among non-Hispanic Others to 11% among Hispanics, and from 21.5% among those who didn't graduate from high school to 8% among college graduates.
Overall, the pooled analysis reveals that of the estimated 25 million US adults who are still smoking in the US, about 40% experience at least some level of functional difficulty, estimate the researchers.
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. It also relied on self report, which may be subject to imperfect recall, and in this case, societal pressures.
But they point out that smoking cessation initiatives frequently don't factor in disability, prompting them to conclude: "Each disability type may present unique challenges and barriers to using conventional smoking cessation interventions, which can be addressed if considerations relating to universal design are incorporated upfront."
They add: "Understanding that more than 1 in 7 adults who smoke live with a disability, and knowing the type, degree of functional difficulties, and demographic characteristics can aid public health officials in designing interventions to reduce smoking that are appropriate and effective for people with disabilities.
