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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3051 — Smoking Decisions and Behaviors of Individuals with Spinal Cord Injuries and Disorders

Author List:
LaVela SL (Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services & Policy Research, University of Illinois at Chicago)
Miskevics S (Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services & Policy Research)
Spring B (Midwest Center for Health Services & Policy Research, Feinberg School of Medicine, Northwestern University)
Clemmons N (Midwest Center for Health Services & Policy Research)
Janke A (Midwest Center for Health Services & Policy Research)
Weaver FM (Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services & Policy Research, Northwestern University)

Objectives:
To assess nicotine addiction, reasons for smoking, and readiness to quit in persons with spinal cord injuries and disorders (SCI&D) at high risk for respiratory complications.

Methods:
Anonymous cross-sectional survey of a random sample of current or past veteran smokers with SCI&D. Questions included demographics, Fagerstrom Test of Nicotine Dependence, Why You Smoke Scale, and Contemplation Ladder. Descriptive statistics, t-tests, and chi-square tests were used for analyses.

Results:
719 (45%) returned surveys; 684 current or past smokers were used in the analyses. Past smokers were older (63 vs. 56 years, p<0.0001), more likely to have high blood pressure (45% vs. 30%, p=0.0019), less likely to have alcohol problems (4% vs. 8%, 0.0250), depression (17% vs. 34%, <0.0001), and post-traumatic stress (11% vs. 21%, p=0.0020) than current smokers. Among current smokers, 57% had low/very low nicotine addiction levels, 15% medium, and 27% high/very high. Demographics did not differ by addiction level; however highly/very highly addicted smokers were more likely to have high blood pressure (p=0.0094) and multiple co-morbid conditions (p=0.0026) than others. Top reasons for smoking were relaxation (10%), tension reduction (9%), and psychological addiction (9%). One-fourth often think about quitting but have no plans to quit, 20% have made changes in smoking but need to keep working on it. Common cessation methods tried were nicotine patch (27%), pamphlets/books (21%), nicotine gum (19%), and Zyban (16%). Highly/very highly addicted smokers were more likely to have tried individual (p=0.0406) and group counseling (p=0.0036), computer resources (p=0.0226), and self-help tapes (p=0.0005) than others.

Implications:
Literature posits that highly addicted smokers need additional quitting assistance; this describes nearly 1/3 of the SCI&D smokers; therefore methods must be used to overcome barriers and cope with withdrawal. Over 1/2 had low addiction levels, suggesting that they might more readily quit with less aid. None of the reasons for smoking independently motivated the need to smoke.

Impacts:
Research indicates that disabled populations are less likely to receive preventive care than the general population. Services, such as smoking cessation, may need targeting to special populations. This study provides information regarding smoking characteristics in SCI&D which will guide efforts to address varying need.


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