1. Disability, Cigarette Smoking And Health-Related Quality Of Life: NYS Adult Tobacco Survey Harlan R. Juster, PhD Larry L. Steele, PhD Theresa M. Hinman, MPH New York State Department of Health Bureau of Chronic Disease Epidemiology and Surveillance

2. Background Comprehensive Tobacco Use and Prevention Program Tobacco Surveillance and Evaluation Disability and Health Program Disability Surveillance and Evaluation

3. Why disability? Disproportionately affected population Collaborative effort with other programs Intrinsic interest

4. Adult Tobacco Survey Began June, 2003 Stratified by eight areas ~8000 surveys annually Quarterly survey Comprehensive questionnaire

5. Objectives Examine smoking status among a sample of people with (PWD) and without (PWOD) disability Examine the association between disability, smoking status and health- related quality of life (HRQOL) Disability/Smoking vs self-rated health Disability/Smoking vs frequent physical and mental distress

6. Definitions - Smoking “Have you smoked at least 100 cigarettes in your entire life?” “Do you now smoke cigarettes everyday, some days, or not at all?” Current smoking = smoked at least 100 AND now smokes everyday or some days.

7. Definitions - Disability “Are you limited in any way in any activities because of physical, mental, or emotional problems?” “Do you now have any health problems that require you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?” Disability = Yes to either question.

8. Definitions - HRQOL “In general, would you say your health is (excellent, very good, good, fair, or poor)?” “Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?”

9. Definitions - HRQOL “Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

10. Definitions - Other Demographics Age Gender Race/Ethnicity Education Employment Marital

11. Results – PWD Demographics* 1181 PWD/6404 (16.5% weighted) 62% female Mean age = 46.3 (sd = 11.4) 74.0% NHWhite, 10.9% NHBlack, 7.8% Hispanic 60% Some college or higher 51.2% Married or with partner 23.3% Unable to work, 12.9% out of work, 44.9% employed, 8.9% retired *Limited to 18-64 yo

12. Current smoking by gender and age in persons with and without disability

13. Current smoking by race and education in persons with and without disability

14. Current smoking by marital and employment status in persons with and without disability

15. Modeling HRQOL Logistic Regression Criterion = HRQOL Predictor of Interest = Composite Variable between Disability and Smoking Adjusted for demographic covariates

16. Self-Rated Health Adjusted Odds Ratio* T-TestP-value of T-test Not a smoker, No disability 1.00-- Smoker, No disability 2.543.450.0006 Not a smoker, Disability 5.525.94<0.0001 Smoker, Disability 13.136.47<0.0001 *Adjusted for age, race, gender, marital, education, and employment status

17. Frequent Physical Distress Adjusted Odds Ratio* T-TestP-value of T-test Not a smoker, No disability 1.00-- Smoker, No disability 1.320.57ns Not a smoker, Disability 11.188.83<0.0001 Smoker, Disability 12.577.34<0.0001 *Adjusted for age, race, gender, marital, education, and employment status

18. Frequent Mental Distress Adjusted Odds Ratio* T-TestP-value of T-test Not a smoker, No disability 1.00-- Smoker, No disability 2.553.950.0001 Not a smoker, Disability 3.724.69<0.0001 Smoker, Disability 9.776.00<0.0001 *Adjusted for age, race, gender, marital, education, and employment status

19. Conclusions Disability occurs in about 17% of our 18- 64 year old population PWD smoke at higher rates than those without disability. Smoking and disability are associated with lower health-related quality of life including self-rated health, frequent physical and mental distress. Smoking appears to be more highly associated with mental distress than with physical distress.

20. Next Steps PWD who smoke should receive the full benefit of cessation services. Mental health care providers and organizations should be targeted for policy related interventions from TCP. Address tobacco use in mental health populations including outpatients and chronic mentally ill.