title: Multiple tobacco use and increased nicotine dependence among people with disabilities.
abstract: BACKGROUND
  People with disabilities (PWD) are at greatest risk for tobacco use compared to people without disabilities. However, little is known about the use of multiple types of tobacco by PWD.
  
  
  OBJECTIVE
  The purpose of this study was to examine nicotine dependence among a sample of PWD who use multiple types tobacco products. We hypothesized that individuals who used multiple forms of tobacco would have higher levels of nicotine dependence.
  
  
  METHODS
  A tobacco survey was administered to clients who use tobacco and receive services from an organization that provides independent living services to PWD. The self-report brief survey included measures of nicotine dependence and items indicating the types of tobacco products participants used. A total of 113 male and female participants with disabilities (mean age = 51.7, SD = 10.1) participated in the study.
  
  
  RESULTS
  Multiple tobacco use was reported by 16.8% of the participants and was significantly associated with nicotine dependence. Compared to single tobacco product users, multiple tobacco users were more likely to use tobacco within the first 30 min of waking, believe tobacco the first thing in the morning would be the most difficult to give up, and find it hard to not use tobacco in prohibited locations.
  
  
  CONCLUSIONS
  The use of multiple types of tobacco products among PWD disability is relatively common and is associated with greater nicotine dependence. Tobacco cessation interventions targeting PWD should consider the addressing unique challenges of preventing different types of tobacco products.
authors.affiliation: Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, USA. Electronic address: eksoule@vcu.edu.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Soule
authors.affiliation: Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Pomeranz
authors.affiliation: Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Moorhouse
authors.affiliation: Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, USA.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Barnett
mesh_terms: D000328:Adult; D001294:Attitude to Health; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects; D057566:Self Report; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D064424:Tobacco Use / Q000453:epidemiology* / Q000517:prevention & control; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D009538:Nicotine
keywords: Center for Independent Living; Fagerstrom Nicotine Dependence Test; Multiple tobacco use; Tobacco