Review PaperA systematic review of tobacco use among adolescents with physical disabilities
Introduction
Worldwide, an estimated five million deaths are associated with tobacco use annually and this number is expected to grow to more than 10 million in a couple of decades.1 At increased risk for future morbidity and mortality are the 9.5% of adolescents globally who smoke on a regular basis.2 It is estimated that 150 million adolescents worldwide use tobacco3 and every day there are between 82,000 and 99,000 young people starting to smoke worldwide.4 Annually in the US, tobacco use is responsible for 443,000 premature deaths, an estimated 5.1 million years of potential life lost, and $96.8 billion in productivity losses.5
Tobacco use is acknowledged as a pediatric disease that requires serious attention because nearly 80% of smokers begin using tobacco in childhood or adolescence.6 Among adolescents, tobacco use is associated with risks for respiratory illnesses and cardiovascular diseases,7, 8 addiction to other drugs,9 mental disorders and suicide.10 Long-term health consequences of adolescent tobacco use are reinforced by the fact that most adolescents who smoke regularly continue to smoke throughout adulthood.11 With the increasing understanding of the determinants of tobacco use among high risk youth (for example see reviews on adolescents with mental illnesses12 and studies on sexual minorities),13 it is important to examine youth with physical disabilities.
Based on the International Classification of Functioning, Disability and Health, disability is a term that broadly defines impairments, activity limitations, and participation restrictions that can result from personal and environmental factors.14 Aside from the usual challenges of adolescence, those with physical disabilities are at greater risk for drug use issues, mental disorders and suicide as compared to those without physical disabilities.15, 16 In fact, despite the decreasing rates of tobacco use in the general population, there has been little change in tobacco use among those with disabilities.17 Hence, addressing tobacco use, among adolescents with physical disabilities is a pressing issue.
The purpose of this study is to review the extant literature to determine the associations between tobacco use and physical disabilities among adolescents. Our review will focus on tobacco use behaviors and potential differences in such behaviors among girls and boys with physical disabilities. The results of our review will be important in identifying research gaps and generating research questions for examining smoking among youth with physical disabilities.
Section snippets
Methods
This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.18 A comprehensive search of the PubMed database was conducted using the following keywords: Adolescent OR Teen OR Children AND Disability OR Handicap AND Smoking OR Cigarette use OR Tobacco use. The search was limited to English language articles that addressed physical disabilities and tobacco use among adolescents and were published prior to
Description of studies
The studies retrieved from the literature search represent findings from a population of 112,934 of which three studies were from populations in the US, three were from Canada, two were from Switzerland, and one each from Croatia and Australia. Table 1 presents a description of the study participants in terms of demographics, disability status, and tobacco use history. Six studies defined smokers based on smoking frequency and habits (for example frequent smoker, daily smoker, experimenter, and
Discussion
It is important to find out if certain vulnerable subgroups of adolescents, such as those with disabilities, have an increased tendency to use tobacco. Our review found that among nationally representative samples of adolescents (6/10 studies), adolescents with physical disabilities were significantly more likely to use tobacco as compared to adolescents without physical disabilities. However, among studies with non-representative samples (4/10), adolescents with physical disabilities may have
Ethical approval
None sought.
Funding
None declared.
Competing interests
None declared.
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