HEALTH
PROMOTION—General Information
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Highlights
Younger women with
disabilities are significantly more likely to smoke than non-disabled women in
the same age group.
A national survey conducted by the Center for Research on Women
with Disabilities in 1997 found higher rates of smoking among women with a
variety of disabilities than typical in the general population, with 32% of
women with disabilities smoking compared to 23% of adults in general. An
analysis of the National Health Interview Study revealed that smoking among
young women with disabilities is nearly double the rate of smoking among young
women in the general population.
Distressingly, data from
the National Health Interview Survey indicate that women with major lower
extremity mobility limitations were less likely to be asked about smoking
behavior by their physicians.
There have been no studies conducted on the consequences of smoking in women with mobility impairments.
In the general population, cigarette smoking is associated with
numerous serious health problems, including cardiopulmonary disease, cancers,
heart disease, cerebrovascular disease, peptic ulcer
disease, peripheral vascular disease, and infertility, as well as a variety of
irreversible health effects on the respiratory system, heart and circulatory
system, eyes, digestive system, skin, and other organs.
While smoking is a
substantial risk factor for disease and death for anyone, it may impart even
higher risks for people with disabilities. For example, research has revealed
that smoking is associated with:
1.
increased risk of, and delayed healing of, pressure sores;
2.
length of time it takes for a wound to heal;
3.
poor post-operative outcome in spinal surgeries and joint replacement
procedures.
Many persons with mobility
limitations and certain disability types have reduced circulatory functioning,
and they are prone to increased healing time. It is possible that, given these
findings, a person with such a disability who smokes would compound this
problem further.
Furthermore, smoking is associated with
osteoporosis in women in the general population. As women with mobility
impairments already have higher rates of osteoporosis, it is possible that
smoking would place a woman with a disability at even greater risk for
fractures and further limitations in functioning.
Although there have been no
studies conducted on the consequences of smoking in women with disabilities,
some researchers have investigated the consequences of smoking in people with
specific conditions. For example, cigarette smoking appears to play an
important role in the progression and severity of rheumatoid arthritis. In
persons with cutaneous lupus erythematosus,
smoking may cause patients to be less responsive to standard treatments. Some
researchers report that pulmonary function was significantly lower in smokers
with spinal cord injury. In people who have multiple sclerosis, cigarette
smoking may negatively impact the central nervous system and produce a
temporary weakening of motor functioning. Additionally, for below-knee amputees
with vascular etiology, smoking decreases walking distance and the ability to
walk outdoors, and increases walking time.
Furthermore, some evidence suggests
that cigarette smoking plays a role in the development of rheumatoid arthritis
and multiple sclerosis, and increases one’s risk for limb amputation.
There have been no studies conducted on how best to help women
with disabilities to stop smoking.
There are few health promotion programs devoted to smoking cessation for people with disabilities. The authors are aware of only one smoking cessation project oriented specifically for women with disabilities, a health promotion campaign in Canada. This program is a self-help intervention available through the internet. The internet site can be accessed at: http://www.hc-sc.gc.ca/hecs-sesc/tobacco/quitting/awayout/chap04.html.
Given the high rates of
smoking among women with disabilities and the increased risk for secondary
conditions, smoking cessation efforts for this population should be given
higher priority. Future research should attempt to identify smoking cessation
strategies best suited to women with disabilities, who may have significant
transportation or cost barriers. Smoking cessation programs available to the
general population should conduct outreach to women with disabilities and work
to raise the awareness of additional adverse health effects for this
population. Researchers should also consider developing programs specifically
for women with disabilities.
Additionally, physicians should become more
aware of the heightened risks associated with smoking for women with
disabilities and regularly discuss smoking behaviors with disabled patients. As
data from the National Health Interview Survey indicates, women with major
lower extremity mobility limitations were less likely to be asked about smoking
behavior by their physicians. Arguably, physicians should be concentrating
their smoking cessation efforts towards this very group.
Further research
is also needed to clarify the relationship between smoking and the
aforementioned secondary conditions.
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