Adults with cognitive disabilities more than twice as likely to use e-cigarettes

The rapid growth of e-cigarette use is a major public health problem in the United States—with significant attention on use among adolescents and young adults. Although manufacturers of e-cigarettes tout their products as safer alternatives to cigarette smoking, research has shown that e-cigarettes can be as hazardous as traditional tobacco products but appeal to those who were never cigarette smokers.

In the first study to assess national use of e-cigarettes among adults with disabilities, George Mason University's College of Health and Human Services researchers found that adults with disabilities were twice as likely to use e-cigarettes (8.4%) than adults without disabilities (4.8%), but the prevalence of e-cigarette use varied by type of disability.

Dr. Gilbert Gimm led the study published in Disability and Health Journal.

"Previous studies have found that e-cigarette use is associated with a greater risk of cardiovascular disease, depression, and adverse health outcomes. Also, smokers with disabilities are less likely to receive advice from their physicians to stop smoking," explains Gimm. "Our study shows that adults with disabilities are a high-risk group for e-cigarette use and therefore at greater risk for adverse health outcomes."

Gimm and colleagues assessed e-cigarette use among 560,858 working age adults (18-64 years) with and without disabilities by using data from the 2017-2018 Behavioral Risk Factor and Surveillance System (BRFSS) survey. With a nationally representative sample, they estimated the prevalence of e-cigarette use among adults by type of disability.

They found that e-cigarette use was more than twice as likely among adults with a cognitive disability (12.0%), an independent living disability (11.0%), or two or more disabilities (9.2%), compared to adults without disabilities (4.8%). Adults with disabilities who were previously smokers were more likely to use e-cigarettes than adults with disabilities who never smoked.

"We know from prior studies that adults with cognitive disabilities have higher rates of mental health conditions such as severe depression and anxiety, and we think this might be a reason for greater e-cigarette use among this population," adds Gimm. "Detailed information on mental health conditions wasn't available in our sample, so we hope future research can shed light on this potential contributor to e-cigarette use in these groups."

Regardless of reported disability status, men were more likely to use e-cigarettes than women, and young adults (18-24 years) were six times as likely use e-cigarettes than middle-aged adults (45-54 years). Adults with COPD or depression were also more likely to use e-cigarettes.

This study highlights the need for more targeted smoking cessation treatments for adults with cognitive disabilities and other high-risk groups. In the future, Gimm and colleagues plan to conduct future research on the use of e-cigarettes among adults with disabilities.