Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Apr 1.
Published in final edited form as: J Adolesc Health. 2023 Dec 3;74(4):764–773. doi: 10.1016/j.jadohealth.2023.09.018

Patterns of alcohol, marijuana, and tobacco use among U.S. adolescents and young adults by disability status: 2015–2019

Jonathan A Schulz a, Gilbert Gimm b, Julia C West a,c, Loren Kock a, Andrea C Villanti d,e
PMCID: PMC10960707  NIHMSID: NIHMS1936485  PMID: 38043040

Abstract

Purpose:

To estimate the national prevalence of tobacco, marijuana, and alcohol use among U.S. adolescents (age 12–17) and young adults (age 18–25; AYAs) with a disability and examine associations between disability and substance use from 2015–2019.

Methods:

Data from the 2015–2019 National Survey on Drug Use and Health were used to estimate the prevalence of tobacco, marijuana, and alcohol use among AYAs with disabilities. Modified Poisson regression models evaluated linear time trends in past-month substance use and estimated adjusted prevalence ratios (aPR) for past-month cigarette, any tobacco, alcohol, and marijuana use.

Results:

Adolescents with any disability had a higher prevalence of past-month cigarette (aPR=1.87; 95% CI 1.67–2.09), alcohol (aPR=1.21; 95% CI 1.11–1.31), and marijuana use (aPR=1.47; 95% CI 1.36–1.60) compared to those without disabilities. Cigarette smoking among adolescents decreased over this time period; however, the decline among adolescents without a disability was greater than those with any disability. Young adults with any disability had a higher prevalence of past-month cigarette (aPR=1.42; 95% CI 1.35–1.48) and marijuana use (aPR=1.39; 95% CI 1.34–1.45), but a lower prevalence of past-month alcohol use (aPR=0.93; 95% CI 0.90–0.95) than those without disabilities. Alcohol use remained constant among young adults with any disability but decreased for those without disabilities.

Conclusion:

Population-level disparities in cigarette and marijuana use exist in AYAs with disabilities. Future studies should identify strategies tailored to AYAs with disabilities to encourage smoking cessation and prevent cannabis use disorder.

Keywords: persons with disabilities, tobacco use, alcohol use, marijuana use

From 2016–2021, past 30-day marijuana use in U.S. young adults (aged 19–30) increased (33.8% to 42.6%) while past 30-day use of alcohol and tobacco decreased (83.5% to 81.8% and 14.3% to 9.0%, respectively).1 Among U.S. adolescents in 8th, 10th, and 12th grade during this same time period, marijuana use declined from 13.7% to 11.0%, alcohol use decreased (19.8% to 15.1%), and cigarette use continuously decreased (5.9% to 2.3%).2 However, these overall changes in substance use mask subgroup differences of relevance to health equity, including differences in patterns of use among people with disabilities.

Disability is defined as the interaction between a person’s health conditions, environment, and personal factors which limit functioning and community participation.3 In practice, disability is identified in population-level surveys as self-reported limitations in domains such as hearing, vision, cognition, mobility, or daily activities (e.g., bathing, dressing).4,5 Limitations in these domains put people at risk of restricted social participation in an unaccommodating environment.6 AYAs living with a disability constitute a sizeable subpopulation of these age groups (estimates range from ~6% of the population aged 14–247 to around 25% of adolescents aged 12–178), yet, few studies have investigated patterns of tobacco, alcohol, and marijuana use in AYAs with disabilities. The existing studies that have examined substance use in AYAs with disabilities are limited by the inclusion of only one or a subset of disabilities, age groups, substances, educational settings, or geographic regions.

Nationally-representative studies on tobacco and nicotine use in the U.S. have reported that students in grades 9–12 with physical disabilities had a greater odds of current cigarette use in 2005;9,10 students in middle and high school had a higher odds of initiating tobacco at 13 years or younger as compared to those without a disability in 201711; students in 6th–12th grade with cognitive disabilities had a greater odds of any tobacco, cigarette, and e-cigarette use in 2019;11 and college students with any disability had greater odds of ever and current cigarette use in 2017.12 In 2015 and 2017, data from one state showed 11th graders with any disability had greater odds of currently using combustibles, electronic nicotine delivery systems, or both and had a significantly higher prevalence of initiating cigarette use before age 14 than 11th graders without a disability.13

Studies on the association between disability and alcohol use among AYAs indicate different risk patterns depending on disability domain. For example, most research related to alcohol use shows that AYAs with intellectual disabilities consume alcohol at lower rates than their peers without a disability.14 However, U.S. data collected in 1994–1995 and 2005 suggest that students in 7th–12th grade with mobility impairments or a physical disability are more likely to report alcohol use,9,15 as are students in 7th–12th grade with emotional disabilities.15

A single study on marijuana using a representative sample of U.S. college students in 2017 showed that students with disabilities had a higher prevalence of past-month marijuana use than students without disabilities.16 Another study found U.S. adults (aged 18–64) with disabilities had a higher prevalence of marijuana use (16.6% vs. 10.9%) compared to those without.17

The purpose of this paper was to update national prevalence estimates of tobacco, marijuana, and alcohol use for adolescents aged 12–17 and young adults aged 18–25 by disability status and domain, describe associations between substance use and disability, and provide substance use trends by age group and disability domain from 2015–2019.

Methods

Data were obtained from the National Survey on Drug Use and Health (NSDUH), an annual survey on health information for people 12 years and older in the United States.18 Analyses included the years 2015–2019 and respondents aged 12–25 years old (n = 138,179). This secondary analysis was determined to not be human subjects research by the University of Vermont Institutional Review Board.

Measures

Disability

Participants were identified as having a self-reported disability by using the following questions: 1) “Are you deaf or do you have serious difficulty hearing?” (hearing); 2) “Are you blind or do you have serious difficulty seeing, even when wearing glasses?” (vision); 3) “Because of a physical, mental or emotional condition, do you have serious difficulty concentrating, remember, or making decisions?” (cognition); 4) “Do you have serious difficulty walking or climbing stairs?” (mobility); 5) “Do you have difficulty dressing or bathing?” (self-care); and 6) “Because of a physical, mental or emotional condition, do you have difficulty doing errands alone such as visiting a doctors’ office or shopping?” (independent living; asked only of respondents aged 15+). A respondent could answer “yes” to multiple disability questions and those who responded “yes” to any of the questions was considered to have a disability.

Tobacco, Alcohol, and Marijuana Use

Derived variables within the NSDUH dataset assessed ever and past-month use of alcohol, marijuana, and the following tobacco products: cigarette, cigars, pipe, smokeless, and any tobacco.4 Mean number of days of cigarette, cigar, smokeless tobacco, alcohol, and marijuana use was estimated from a recode of the question: “how many days smoked/used [substance] in past 30 days” among those who indicated past-30 day use. Age of initiation was calculated from the recoded variable for age of first use for cigarettes, cigars, smokeless tobacco, alcohol, and marijuana. NSDUH did not include measures related to e-cigarette use until 2020; therefore, e-cigarette use was not assessed in this study.

Sociodemographic Characteristics

Age group was defined as adolescents (ages 12–17) and young adult (ages 18–25). Participant characteristics assessed in both age groups included sex (male / female), race/ethnicity (Hispanic, Non-Hispanic (NH) White, NH Black, Other), annual household income (<$20,000, $20,000–$49,000, $50,000–$74,999, ≥$75,000), and any health insurance (yes/no). Additional items asked only of young adults included sexual orientation (bisexual, heterosexual, lesbian or gay), education (less than high school, high school diploma/GED, some college/associate degree, Bachelor’s degree or more), and past year serious psychological distress (yes/no).

Data Analysis

All analyses were conducted using Stata Version 17 (StataCorp LP, College Station, TX) and R v4.2.119 (packages “survey”20 and “interactions”21) and used survey weights to account for complex survey design. Taylor series estimation produced accurate standard errors and all prevalence estimates followed NSDUH suppression guidelines.18 List-wise deletion was used to remove missing data, refused, and I don’t know responses. Derived variables contained no missing, refused, or I don’t know data, for the remaining variables (i.e., disability status, sociodemographic characteristics), missing data ranged from 0%–1.7%. Descriptive statistics were analyzed for sociodemographic variables and chi-square tests were used to test for differences in the distribution of characteristics. The prevalence of ever use and past-month use for all products (i.e., cigarettes, cigars, pipe tobacco, smokeless, any tobacco, alcohol, marijuana) with 95% CIs for combined 2015–2019 data was estimated for each disability domain by function in AYAs. Mean number of days and age of initiation with 95% CIs were estimated for cigarettes, cigars, smokeless tobacco, alcohol, and marijuana by disability domain and age group. The prevalence of past-month cigarette, alcohol, and marijuana use were estimated for each year for any disability by age group. Modified Poisson regression models evaluated linear time trends in past-month substance use with any disability status as the exposure of interest. These models included an interaction between disability and year to explore whether the time trends depended on disability status.

Modified Poisson regression models also examined the association between disability status and past-month cigarette, any tobacco, alcohol, and marijuana use, adjusting for sex, race/ethnicity, annual household income, health insurance, and year. These models produced an adjusted prevalence ratio (aPR) for any disability and each of the six disability domains in each age group, with people with no disability and without each respective disability serving as the reference group. Statistical significance was evaluated using two tailed tests and an α value of 0.05. Two sensitivity analyses were conducted: 1) a model in young adults adjusting for sexual orientation, education, and past-year psychological distress and 2) a model assessing substance use by those who only endorsed a single disability domain or multiple disabilities.

Results

The analytic sample included adolescents (n = 68,263) and young adults (n = 69,916). The overall prevalence of adolescents endorsing any of the disability domains was 20.8% and in young adults was 16.7% (Table 1).

Table 1.

Study Population Characteristics. Data are combined from the 2015–2019 National Survey on Drug Use and Health.

Characteristic Total na=138,179
na=68,263
Adolescents (12–17)		 na=69,916
Young Adults (18–25)
No Disability %b (95% CI) Any Disabilityc %b (95% CI) No Disability %b (95% CI) Any Disabilityc %b (95% CI)
Disability 79.2 (78.8, 79.6) 20.8 (20.4, 21.2) 83.4 (83.0, 83.7) 16.7 (16.3, 17.0)
 Cognitived 84.3 (83.9, 84.6) 15.7 (15.4, 16.1) 89.1 (88.7, 89.4) 11.0 (10.6, 11.3)
 Hearingd 98.0 (97.9, 98.1) 2.0 (1.9, 2.2) 98.4 (98.3, 98.5) 1.6 (1.5, 1.7)
 Independent Livingd,e 97.4 (97.2, 97.5) 2.6 (2.5, 2.8) 95.3 (95.1, 95.5) 4.7 (4.5, 4.9)
 Mobilityd 98.5 (98.4, 98.6) 1.5 (1.4, 1.6) 98.5 (98.4, 98.6) 1.5 (1.4, 1.6)
 Self-cared 99.3 (99.2, 99.4) 0.7 (0.7, 0.8) 99.4 (99.3, 99.5) 0.6 (0.6, 0.7)
 Visiond 95.4 (95.2, 95.6) 4.6 (4.4, 4.9) 96.1 (95.9, 96.3) 3.9 (3.7, 4.1)
Sex
 Male 53.2 (52.6, 53.8) 42.3 (41.1, 43.4) 51.8 (51.2, 52.4) 41.9 (40.7, 43.0)
 Female 46.8 (46.2, 47.4) 57.8 (56.6, 58.9) 48.2 (47.6, 48.8) 58.1 (57.0, 59.3)
Sexual Orientation
 Bisexual f f 6.5 (6.3, 6.8) 17.5 (16.8, 18.3)
 Heterosexual or straight f f 91.0 (90.7, 91.3) 78.3 (77.4, 79.1)
 Lesbian or gay f f 2.5 (2.3, 2.6) 4.2 (3.8, 4.7)
Race/ethnicity
 Hispanic 23.5 (22.9, 24.1) 25.9 (24.8, 27.0) 22.2 (21.5, 22.9) 21.2 (20.0, 22.4)
 Non, Hispanic (NH) White 53.2 (52.5, 53.8) 50.6 (49.6, 51.6) 53.6 (52.7, 54.4) 57.7 (56.4, 59.1)
 NH Black 13.4 (12.8, 14.0) 14.5 (13.7, 15.5) 14.3 (13.9, 14.7) 12.6 (11.8, 13.5)
 Otherg 10.0 (9.6, 10.4) 9.0 (8.4, 9.7) 10.0 (9.6, 10.4) 8.5 (7.9, 9.2)
Education completed
 Less than High School f f 13.1 (12.7, 13.6) 17.7 (17.0, 18.5)
 High school diploma/GED f f 29.8 (29.2, 30.5) 35.5 (34.5, 36.5)
 Some college / Associate degree f f 41.3 (40.6, 42.1) 38.8 (37.7, 40.0)
 Bachelor’s degree or more f f 15.7 (15.1, 16.4) 8.0 (7.2, 8.8)
Annual household income ($)
 <20,000 14.4 (13.9, 15.0) 18.5 (17.5, 19.6) 26.7 (26.0, 27.5) 29.9 (28.8, 31.1)
 20,000, 49,999 26.4 (25.9, 27.0) 31.4 (30.2, 32.5) 31.8 (31.1, 32.4) 32.9 (31.8, 34.1)
 50,000, 74,999 14.3 (13.8, 14.7) 14.7 (14.0, 15.4) 14.1 (13.7, 14.5) 12.4 (11.7, 13.1)
 >=75,000 44.9 (44.1, 45.6) 35.4 (34.1, 36.8) 27.4 (26.8, 28.1) 24.8 (23.6, 26.1)
Health Insurance
 Yes 95.6 (95.4, 95.9) 95.6 (95.1, 96.1) 86.2 (85.8, 86.6) 85.4 (84.6, 86.2)
 No 4.4 (4.1, 4.7) 4.4 (3.9, 4.9) 13.8 (13.5, 14.2) 14.6 (13.8, 15.4)
Past year serious psychological distress
 Yes f f 17.7 (17.3, 18.1) 53.1 (52.0, 54.2)
 No f f 82.3 (81.9, 82.8) 46.9 (45.8, 48.0)
Open in a new tab

Note. CI = Confidence Interval.

a

Number reflects the unweighted sample size

b

Percentages are weighted

c

Respondents who indicated “yes” to any of the American Community Survey six-item set of questions to measure disability

d

The weighted prevalence of respondents who indicated “yes” to the respective disability type is listed in the “any disability” column

e

Asked only of participants aged 15+ years

f

Not asked of participants aged 12–17 years

g

NH Native American/Alaskan Native, NH Hawaiian/Pacific Islander, NH Asian, NH more than one race

A greater proportion of AYAs with any disability were female, had a lower household income, and report illicit drug use in the past month compared to those without (Table 1). A greater proportion of young adults with a disability reported past year serious psychological distress and less educational attainment than young adults without a disability.

Adolescents

Tobacco use

Pooled 2015–2019 data indicated that adolescents with any disability had a higher prevalence of ever cigarette (16.1% vs. 9.6%), ever cigar (7.8% vs 5.6%), ever pipe (2.7% vs 1.3%), ever smokeless (5.4% vs 4.6%), and ever any tobacco use (19.9% vs. 13.4%; Table 2) than peers without a disability. Past-month prevalence of all tobacco products except smokeless was also higher for adolescents with any disability compared to those without. All disability domains had higher past-month cigarette use and any tobacco use compared to no disability. Overall, tobacco use declined in both adolescents with and without a disability from 2015–2019 (Figure 1); however, there was a significant interaction (p = 0.05) such that the slope for the decline in tobacco use was steeper among those without a disability than those with a disability (Figure S1). There was no difference in number of days smoked cigarettes in the past month for adolescents with any disability; however, adolescents with a vision disability smoked more days than those without a vision disability (14.8 vs. 10.3). Adolescents with any disability also had a younger age of initiation than those without a disability for cigarettes (12.9 vs. 13.2) and cigars (13.9 vs. 14.2). After adjusting for sociodemographic variables, adolescents with any disability had a higher prevalence of past-month cigarette (aPR=1.87; 95% CI 1.67–2.09) and past-month tobacco use (aPR=1.64; 95% CI 1.50–1.78; Figure 2). Adolescents in each disability domain had a higher aPR of past-month cigarette and any tobacco use.

Table 2.

Ever use, past-month use, mean number of days used, and age of initiation for four tobacco products, alcohol, and marijuana for adolescents (age 12–17) by disability type. Data are combined from the 2015–2019 National Survey on Drug use and Health.

Ever use Past-month use Mean # of days used in the past month Age of initiation
Prevalencea (95% CI) Prevalencea (95% CI) n b Mean 95% CIa n c Mean 95% CIa
Cigarettes
 No disability 9.6 (9.3, 10.0) 2.8 (2.6, 2.9) 1,631 10.3 (9.6, 11.0) 5,474 13.2 (13.1, 13.3)
 Any 16.1 (15.3, 16.9) 5.1 (4.7, 5.6) 837 12.1 (10.9, 13.2) 2,566 12.9 (12.7, 13.0)
 Cognitive 16.7 (15.9, 17.6) 5.4 (4.9, 5.9) 654 11.8 (10.6, 13.1) 1,974 12.8 (12.6, 12.9)
 Hearing 18.1 (15.9, 20.6) 5.8 (4.6, 7.4) 84 10.6 (8.0, 13.2) 260 12.6 (12.3, 13.0)
 ILcd 26.4 (23.7, 29.3) 10.0 (8.4, 11.9) 191 13.0 (10.6, 15.4) 517 13.2 (12.9, 13.6)
 Mobility 17.6 (14.9, 20.6) 7.1 (5.3, 9.4) 76 12.6 (9.3, 15.9) 206 12.6 (12.2, 13.1)
 Self-care 14.3 (10.3, 19.4) 5.3 (3.6, 7.8) 26 14.9 (8.0, 21.7) 64 11.3 (9.9, 12.6)
 Vision 15.1 (13.7, 16.6) 4.8 (3.9, 5.9) 179 14.8 (12.1, 17.6) 546 12.9 (12.6, 13.1)
Cigars
 No disability 5.6 (5.4, 5.8) 1.5 (1.4, 1.7) 917 5.9 (5.2, 6.5) 3,138 14.2 (14.2, 14.3)
 Any 7.8 (7.3, 8.4) 2.7 (2.3, 3.0) 386 6.6 (5.6, 7.7) 1,212 13.9 (13.8, 14.1)
 Cognitive 8.0 (7.4, 8.6) 2.8 (2.4, 3.2) 294 6.4 (5.1, 7.7) 919 13.9 (13.7, 14.0)
 Hearing 8.1 (6.6, 10.0) 2.3 (1.6, 3.2) 40 5.4 (2.4, 8.4) 117 13.2 (12.8, 13.7)
 ILd 13.0 (11.1, 15.1) 4.2 (3.2, 5.5) 73 6.9 (4.9, 9.0) 249 14.4 (14.2, 14.6)
 Mobility 9.2 (7.1, 12.0) 4.1 (3.0, 5.5) 41 6.9 (4.5, 9.2) 95 13.5 (13.0, 14.0)
 Self-care 7.9 (5.3, 11.7) 4.2 (2.1, 8.2) 17 4.8 (-,-) 36 12.9 (10.5, 15.4)
 Vision 8.7 (7.8, 9.7) 3.1 (2.4, 4.0) 94 6.3 (5.1, 7.6) 281 13.9 (13.6, 14.2)
Pipe Tobacco
 No disability 1.3 (1.2, 1.4) 0.3 (0.3, 0.4) e e e e
 Any 2.7 (2.4, 3.0) 0.7 (0.5, 0.9) e e e e
 Cognitive 3.1 (2.6, 3.6) 0.8 (0.6, 1.1) e e e e
 Hearing 2.3 (1.4, 3.7) 0.3 (0.1, 0.9) e e e e
 ILd 4.7 (3.5, 6.3) 0.9 (0.5, 1.6) e e e e
 Mobility 3.6 (2.4, 5.3) 0.9 (0.5, 1.6) e e e e
 Self-care 2.4 (1.2, 4.8) 0.7 (0.2, 2.2) e e e e
 Vision 2.3 (1.7, 3.3) 0.5 (0.3, 0.8) e e e e
Smokeless
 No disability 4.6 (4.4, 4.9) 1.2 (1.2, 1.3) 746 11.5 (10.6, 12.4) 2,605 13.8 (13.6, 13.9)
 Any 5.4 (4.9, 6.0) 1.4 (1.1, 1.6) 225 10.8 (9.1, 12.4) 879 13.5 (13.2, 13.7)
 Cognitive 5.4 (4.8, 6.0) 1.4 (1.2, 1.8) 170 10.1 (8.3, 11.8) 639 13.5 (13.2, 13.7)
 Hearing 8.1 (6.3, 10.2) 2.7 (1.5, 4.6) 34 8.9 (3.7, 14.1) 118 12.6 (12.1, 13.2)
 ILd 7.2 (5.8, 9.0) 1.5 (0.9, 2.4) 30 5.5 (−1.3, 12.4) 149 14.1 (13.7, 14.5)
 Mobility 5.3 (4.1, 6.9) 1.3 (0.8, 2.2) 17 12.3 (1.4, 23.2) 65 12.8 (12.0, 13.7)
 Self-care 5.6 (2.9, 10.3) 1.9 (0.9, 3.9) 9 9.1 (-,-) 30 11.9 (9.7, 14.2)
 Vision 5.3 (4.4, 6.3) 1.2 (0.8, 1.8) 44 9.7 (6.1, 13.2) 192 13.4 (13.0, 13.9)
Any tobacco
 No disability 13.4 (13.0, 13.9) 4.3 (4.1, 4.6) e e e e
 Any 19.9 (19.1, 20.6) 6.9 (6.5, 7.4) e e e e
 Cognitive 20.3 (19.5, 21.2) 7.3 (6.8, 7.9) e e e e
 Hearing 23.0 (20.6, 25.7) 7.7 (6.3, 9.4) e e e e
 ILd 30.7 (27.9, 33.6) 11.8 (10.0, 13.8) e e e e
 Mobility 22.2 (19.0, 25.7) 9.7 (7.8, 11.9) e e e e
 Self-care 19.4 (14.7, 25.3) 7.8 (5.4, 11.2) e e e e
 Vision 19.2 (17.8, 20.7) 6.6 (5.7, 7.7) e e e e
Alcohol
 No disability 25.9 (25.3, 26.5) 9.1 (8.8, 9.4) 4,943 3.4 (3.2, 3.5) 14,128 13.8 (13.8, 13.9)
 Any 33.1 (32.0, 34.2) 10.9 (10.1, 11.8) 1,656 3.7 (3.4, 4.0) 4,951 13.3 (13.2, 13.4)
 Cognitive 33.3 (32.1, 34.6) 11.0 (10.1, 11.9) 1,241 3.7 (3.4, 4.0) 3,706 13.2 (13.1, 13.4)
 Hearing 30.8 (28.2, 33.6) 9.6 (7.6, 12.1) 150 3.7 (3.0, 4.5) 457 13.1 (12.8, 13.4)
 ILd 48.4 (45.4, 51.3) 17.1 (14.7, 19.9) 321 3.4 (2.9, 4.0) 915 13.8 (13.6, 14.1)
 Mobility 33.0 (28.8, 37.5) 10.3 (8.2, 12.8) 124 4.1 (3.1, 5.1) 376 12.9 (12.6, 13.1)
 Self-care 27.1 (22.2, 32.6) 7.3 (4.8, 11.0) 38 3.5 (1.9, 5.1) 133 12.6 (11.8, 13.3)
 Vision 34.3 (32.3, 36.4) 11.4 (10.1, 12.9) 372 3.8 (3.2, 4.4) 1,132 13.2 (13.0, 13.4)
Marijuana
 No disability 14.1 (13.7, 14.6) 6.2 (6.0, 6.4) 3,513 9.7 (9.3, 10.1) 7,957 14.1 (14.1, 14.2)
 Any 20.6 (19.7, 21.5) 9.1 (8.5, 9.8) 1,462 10.8 (10.1, 11.4) 3,207 13.8 (13.7, 13.9)
 Cognitive 20.7 (19.6, 21.8) 9.2 (8.4, 10.1) 1,100 10.7 (9.9, 11.6) 2,393 13.8 (13.7, 13.9)
 Hearing 18.5 (16.2, 21.2) 8.8 (7.0, 11.0) 128 10.6 (7.5, 13.6) 281 13.3 (12.9, 13.8)
 ILd 34.8 (32.2, 37.4) 15.1 (13.3, 17.0) 302 11.7 (10.3, 13.1) 674 14.0 (13.8, 14.3)
 Mobility 21.6 (18.3, 25.2) 10.5 (8.1, 13.4) 120 10.4 (7.5, 13.3) 256 13.5 (13.2, 13.8)
 Self-care 19.0 (15.7, 22.7) 7.4 (5.3, 10.3) 41 11.2 (4.8, 17.7) 89 13.2 (12.5, 13.9)
 Vision 22.6 (20.7, 24.7) 10.3 (9.2, 11.6) 360 10.7 (9.4, 12.1) 761 13.6 (13.4, 13.8)
Open in a new tab

Note. CI = Confidence Interval; IL = Independent Living.

a

Percentages are weighted

b

Number reflects the unweighted sample size of those who reported using the substance in the past month

c

Number reflects the unweighted sample size of those who reported ever using the substance

d

Asked only of participants aged 15+ years

e

Question not asked in the survey

Figure 1.

Figure 1.

Open in a new tab

Weighted prevalence of adolescents and young adults indicating past-month tobacco, alcohol, and marijuana use by year. Data are from the 2015–2019 National Survey on Drug Use and Health.

Note. Prevalence with 95% confidence intervals. Along the y-axis is percent. Along the x-axis is year. Estimates are weighted.

Figure 2.

Figure 2.

Open in a new tab

Adjusted prevalence ratios of past-month cigarette, any tobacco, alcohol, and marijuana use by disability and functioning domain. Data are combined from the 2015–2019 National Survey on Drug Use and Health.

Note. Prevalence ratios with 95% confidence intervals adjusting for sex, race/ethnicity, annual income, health insurance, and year. Along the y-axis are disability and domain. The x-axis uses a log scale and represents the adjusted prevalence ratio. Estimates are weighted. Boldface indicates statistical significance (p<0.05) with people without each respective disability serving as the reference group.

Alcohol use

Adolescents with any disability had a higher prevalence of ever alcohol use (33.1% vs. 25.9%) and past month alcohol use (10.9% vs. 9.1%) compared to those without a disability. Adolescents with a cognitive (11.0%), independent living (17.1%), and vision (11.4%) had a higher prevalence of past-month alcohol than those without that respective disability; there were no differences in the prevalence of alcohol use in the remaining disability domains (i.e., hearing, mobility, and self-care). The prevalence of alcohol use among adolescents remained constant from 2015–2019 (p > 0.05) (Figure 1) and there was no interaction between disability status and year (Figure S2). Adolescents with any disability initiated alcohol use at a younger age than those without a disability (13.3 vs 13.8). After adjusting for covariates, adolescents with any disability had a higher aPR of past-month alcohol use (aPR=1.21; 95% CI 1.11–1.31). Adolescents with a cognitive disability (aPR=1.18; 95% CI 1.08–1.28) and a visual disability (aPR=1.27; 95% CI 1.14–1.43) also had a higher aPR of past-month alcohol use, while all other disability domains had a similar prevalence of alcohol use (Figure 2).

Marijuana use

Adolescents with any disability had a higher prevalence of ever marijuana use (20.6% vs. 14.1%) and past month marijuana use (9.1% vs. 6.2%) compared to those without a disability. Adolescents with all disability domains except self-care also had a higher prevalence of past-month marijuana than those without. The prevalence of marijuana use among adolescents remained constant from 2015–2019 (p > 0.05; Figure 1). There was no interaction between disability status and year (Figure S3). Adolescents with any disability initiated marijuana use at a younger age than those without (13.8 vs 14.1). After adjusting for covariates, adolescents with any disability had a higher prevalence of past-month marijuana use (aPR=1.47; 95% CI 1.36–1.60). Adolescents with all disability domains except self-care also had a higher adjusted prevalence of past-month marijuana use compared to those without (Figure 2).

Young adults

Tobacco use

Young adults with any disability had a higher prevalence of ever cigarette use (54.4% vs. 47.3%), ever cigar use (36.0% vs 33.1%), ever pipe use (11.4% vs 8.3%), and ever any tobacco use (61.2% vs. 56.6%; Table 2). Past-month prevalence of all tobacco products except smokeless tobacco was also higher for young adults with any disability. The prevalence of tobacco use among young adults decreased from 2015–2019 (p < 0.001; Figure 1) and there was no interaction between disability status and year (Figure S4). Young adults with a disability smoked cigarettes a greater average number of days in the past month than those without a disability (18.8 vs. 16.9). All disability domains also smoked cigarettes a greater number of days in the previous month than those without a disability. Young adults with any disability had a younger age of initiation than those without a disability for cigarettes (15.7 vs. 16.3) and cigars (17.3 vs. 17.6). After adjusting for sociodemographic variables, young adults with any disability had a higher prevalence of past-month cigarette (aPR=1.42; 95% CI 1.35–1.48) and past-month tobacco use (aPR=1.31; 95% CI 1.26–1.37; Figure 2). For all disability domains, young adults with a disability had a higher aPR of past-month cigarette and any tobacco use than those without.

Alcohol use

Young adults with any disability had a similar prevalence of ever alcohol use (80.6% vs. 80.9%) and a lower prevalence of past-month alcohol use (52.9% vs. 56.9%) compared to those without a disability. Among those who drank alcohol, people with any and without a disability drank a similar number of days in the previous month (6.7 vs. 6.6). Alcohol use was initiated at a younger age for those with a disability as compared to those without (16.3 vs 16.8). After adjusting for covariates, young adults with any disability had a lower aPR of past-month alcohol use (aPR=0.93; 95% CI 0.90–0.95). Overall, young adults with all disability domains had a lower prevalence than those without a disability (Figure 2). However, from 2015–2019, there was an interaction between disability status and year such that the difference in alcohol use in young adults attenuated over time. Specifically, alcohol use declined in the no disability group, but there was no decline in the any disability group (Figure S5).

Marijuana use

Young adults with any disability had a higher prevalence of ever marijuana use (58.8% vs. 50.6%) and past month marijuana use (27.7% vs. 20.2%) compared to those without. All disability domains except self-care for young adults had a higher prevalence of past-month marijuana than those without a disability. The prevalence of marijuana use among young adults has increased from 2015–2019 (p < 0.05; Figure 1) and there was no interaction between disability status and year (Figure S6). Young adults with any disability used marijuana a greater mean number of days in the past month as compared to those without a disability (16.0 vs. 14.7). Young adults with a disability also initiated marijuana use at a younger age than those without (16.1 vs 16.6). After adjusting for covariates, young adults with any disability had a higher aPR of past-month marijuana use (aPR=1.39; 95% CI 1.34–1.45). All disability domains except self-care had a higher adjusted prevalence of past-month marijuana use (Figure 2).

Sensitivity analyses including additional covariates in young adults and assessing those with only one disability domain showed broadly similar results (Figures S7 and S8). However, adolescents with only a hearing disability no longer had a significant higher prevalence of past-month cigarette, tobacco, or marijuana use.

Discussion

In a nationally representative sample over five years, AYAs with any disability reported higher past-month cigarette, any tobacco, and marijuana use than those without a disability, a finding supported by previous research.12,13,16 AYAs within each disability domain had a higher prevalence of cigarette and any tobacco use compared to those without the respective disability. AYAs with all disability domains except self-care also had higher prevalence of marijuana use. Findings related to alcohol differed by age, with adolescents with any disability reporting a higher prevalence of alcohol use than those without while young adults with any disability had a lower prevalence of alcohol use than those without. Results highlighted differences in alcohol use by disability domain: adolescents with cognitive and vision disabilities had higher prevalence of alcohol use, while all disability domains in young adults had lower prevalence of alcohol use.

This study expands a limited evidence base on substance use among AYAs with disabilities, particularly as it offers recent national and trend data. The results suggest that tobacco use decreased over time in young people with any disability, consistent with previous research in adults with any disability22 and the overall population.1 Additionally, results support that people with disabilities initiate tobacco, alcohol, and marijuana use at an earlier age than those without a disability,11,13 which are important findings since early tobacco initiation is associated with higher nicotine dependence,23 impaired lung growth, and accelerated chronic disease development.24 Likewise, alcohol and marijuana initiation in adolescence is associated with a plethora of negative outcomes, including mental health conditions and poor social functioning with marijuana use25,26 and a higher risk for developing alcohol disorders following early alcohol initiation.27

Findings related to alcohol use among AYAs with disabilities provide new information: although previous research suggests adolescents with intellectual disabilities use alcohol less than peers14,28,29 and adolescents with mobility or emotional disabilities use alcohol more,15 the current study suggests that adolescents with any, cognitive, and vision disabilities have a higher prevalence of alcohol use and adolescents with mobility disabilities have a similar prevalence. This study also suggests that alcohol use in adolescents with any and some domains is higher than in those without disability and that generally, young adults with disabilities have a lower prevalence of alcohol use than their counterparts. However, this difference in alcohol use between young adults with and without disabilities appeared to decrease over time. Finally, while marijuana use in adolescents with any disability has remained constant from 2015–2019, marijuana use in young adults with any disability increased, mirroring national trends.1 State marijuana policies have become less restrictive while federal tobacco policies have become more restrictive, which may help to explain why marijuana use has increased over this time period while tobacco use decreased for AYAs. Past-month marijuana use remains higher in AYAs with any disability than those without, consistent with previous research.15,16 Future research should consider the influence of medical marijuana on overall prevalence among people with disabilities as medical marijuana may be prescribed for a few disorders (e.g., chronic pain, multiple sclerosis symptoms) that may be captured as disabilities in these data.30

There is limited information overall on differences in environmental contexts, social motives, and cultural norms for AYA with and without disabilities; however, possible explanations for higher tobacco, alcohol, and marijuana use among adolescents with disabilities and higher tobacco and marijuana use among young adults with disabilities may relate to social influences on the uptake of substance use in these developmental periods.31,32 Adolescents with a disability have fewer social opportunities and are more likely to experience bullying than those without a disability, which can lead to social isolation and loneliness.33,34 Adolescents with disabilities may also strive to have similar social situations as their peers but fail to participate in these social situations at the same rate, further compounding loneliness and isolation.33 This may, in turn, increase alcohol use in AYAs with disabilities.35,36 Additionally, children with disabilities experience stressful life events at a higher proportion than those without a disability,37 which may influence early onset of alcohol use and increase risk of alcohol consumption.38,39 Primary socialization theory posits that peer influences (e.g., bullying, limited social interactions) may be greater in adolescence, thus increasing alcohol use, then wane as adolescents transition to young adulthood.31,32 Finally, social determinants of health influence adolescent health40 and compared to people without disabilities, people with disabilities are more likely to experience barriers related to these social determinants (e.g., limited access to health resources,41,42 less likely to graduate high school,43 more likely to live in poverty44), which may put AYA with disabilities at greater risk of substance use.

This study had several strengths, including the use of a large, nationally representative survey dataset; the inclusion of alcohol, marijuana, and several tobacco products as measures; and detailed information on AYAs by disability domain. However, there were also data limitations. First, the data are cross-sectional and self-reported. Next, sample sizes for some disability domains were small. Additionally, data are limited to 2015–2019 because 2015 was the year NSDUH began using the American Community Survey six-item disability questions set and 2020 data are deemed not comparable to earlier years due to methodological changes necessitated by the pandemic.45 Also, previously cited studies identify disability differently (e.g., different survey questions10) and therefore results are not directly comparable.

Although asking about disability in national surveys has been mandated since 2011 by Section 4302 of the Affordable Care Act,46 it remains unknown whether local and statewide research and cessation programs aimed to identify and reduce substance use measure disability among participants. These findings suggest that substance use monitoring and surveillance in AYAs with a disability should be prioritized. Screening for substance use in pediatric and adolescent primary care settings is widely recommended as part of routine visits,47 which may aid in early detection and intervention for this population. However, physicians report numerous barriers (e.g., procedural, policy) as well as insufficient knowledge, experience, and skills to provide quality care to people with disabilities48,49 and it is unknown whether adolescents and young adults with disabilities are screened in the same manner as other young people. Provider training or technical assistance in primary care settings may help to close gaps in identifying problematic substance use in AYAs with disabilities. Additionally, prevention and cessation interventions should be tailored for people with disabilities, particularly adolescents. Although current research consistently demonstrates population-level differences in use across various substances between people with and without disabilities of all ages,9,15,16 there remains a dearth of research on interventions to prevent these inequities, especially for adolescents with disabilities.50 A small number of studies address school-based interventions for substance use prevention in adolescents with disabilities recommend the use of repetition, adding skill training (e.g., refusal skills), involving parents, educational learning activities, and role playing.51–53 Future research should investigate what factors are associated with disproportionate substance use by people with disabilities, including social and environmental barriers, risk perceptions, and quit attempts and methods to aid in creating effective prevention and cessation interventions for this population.

Supplementary Material

1

Table 3.

Ever use, past-month use, mean number of days used, and age of initiation for four tobacco products, alcohol, and marijuana for young adults (age 18–25) by disability type. Data are combined from the 2015–2019 National Survey on Drug use and Health.

Ever use Past-month use Mean # of days used in the past month Age of initiation
Prevalencea (95% CI) Prevalencea (95% CI) n b Mean 95% CIa n c Mean 95% CIa
Cigarettes
 No disability 47.3 (46.7, 48.0) 20.6 (20.1, 21.1) 12,384 16.9 (16.6, 17.2) 27,897 16.3 (16.3, 16.3)
 Any 54.4 (53.1, 55.7) 28.6 (27.4, 29.8) 3,643 18.8 (18.4, 19.3) 6,823 15.7 (15.6, 15.8)
 Cognitive 56.0 (54.0, 57.9) 30.3 (28.6, 32.1) 2,484 18.6 (18.0, 19.2) 4,550 15.6 (15.5, 15.7)
 Hearing 56.9 (53.6, 60.1) 31.7 (29.0, 34.6) 426 19.2 (17.7, 20.8) 719 15.4 (15.1, 15.6)
 IL 55.1 (53.2, 57.0) 29.8 (27.7, 32.0) 1,076 20.0 (19.0, 21.1) 1,984 15.4 (15.2, 15.5)
 Mobility 54.1 (49.8, 58.3) 31.2 (27.9, 34.7) 359 20.2 (18.6, 21.8) 617 15.4 (15.1, 15.7)
 Self-care 51.3 (45.5, 57.2) 30.3 (25.2, 35.9) 150 21.0 (19.0, 23.0) 253 15.2 (14.7, 15.7)
 Vision 52.7 (49.8, 55.6) 26.4 (24.8, 28.1) 833 19.3 (18.1, 20.4) 1,592 15.7 (15.6, 15.9)
Cigars
 No disability 33.1 (32.6, 33.6) 8.1 (7.8, 8.4) 4,734 7.1 (6.7, 7.4) 19,222 17.6 (17.5, 17.6)
 Any 36.0 (34.9, 37.2) 10.5 (9.8, 11.2) 1,295 8.3 (7.6, 9.0) 4,475 17.3 (17.2, 17.4)
 Cognitive 38.1 (36.5, 39.8) 11.2 (10.2, 12.2) 876 8.1 (7.3, 9.0) 3,089 17.2 (17.1, 17.4)
 Hearing 37.1 (32.9, 41.5) 11.7 (9.6, 14.2) 166 7.4 (5.8, 9.0) 472 17.4 (17.1, 17.7)
 IL 35.1 (33.7, 38.2) 9.6 (8.3, 11.0) 337 7.5 (6.3, 8.6) 1,275 17.2 (17.0, 17.4)
 Mobility 33.3 (30.0, 36.8) 11.5 (9.7, 13.5) 133 9.2 (6.8, 11.6) 368 16.8 (16.5, 17.1)
 Self-care 37.0 (30.9, 43.6) 14.7 (11.3, 18.8) 67 9.6 (6.8, 12.5) 174 16.6 (15.9, 17.2)
 Vision 30.9 (29.3, 32.6) 10.6 (9.3, 12.1) 310 10.0 (8.4, 11.6) 921 17.2 (16.9, 17.5)
Pipe Tobacco
 No disability 8.3 (8.0, 8.6) 1.4 (1.3, 1.6) d d d d
 Any 11.4 (10.7, 12.2) 2.5 (2.1, 3.0) d d d d
 Cognitive 12.8 (11.8, 13.9) 2.8 (2.3, 3.4) d d d d
 Hearing 13.8 (11.6, 16.4) 3.2 (2.1, 4.7) d d d d
 IL 12.4 (11.0, 13.9) 2.9 (2.2, 3.7) d d d d
 Mobility 12.5 (10.0, 15.5) 2.6 (1.8, 3.9) d d d d
 Self-care 15.0 (11.2, 19.8) 4.4 (2.4, 8.1) d d d d
 Vision 9.3 (7.9, 10.9) 2.9 (2.2, 3.8) d d d d
Smokeless
 No disability 17.8 (17.3, 18.3) 5.1 (4.8, 5.4) 3,130 16.7 (16.3, 17.2) 10,711 16.8 (16.7, 16.9)
 Any 17.7 (16.9, 18.6) 4.4 (3.9, 4.8) 591 13.7 (12.4, 15.1) 2,305 16.5 (16.4, 16.7)
 Cognitive 18.5 (17.4, 19.7) 4.5 (3.9, 5.1) 380 12.6 (11.1, 14.2) 1,548 16.6 (16.4, 16.8)
 Hearing 21.2 (18.3, 24.4) 7.5 (5.8, 9.5) 113 14.8 (11.2, 18.4) 312 16.1 (15.6, 16.5)
 IL 17.1 (15.6, 18.7) 3.3 (2.6, 4.2) 121 14.4 (11.5, 17.2) 618 16.4 (16.2, 16.6)
 Mobility 19.8 (16.4, 23.7) 5.8 (4.2, 7.9) 70 14.1 (10.8, 17.5) 222 15.8 (15.1, 16.5)
 Self-care 21.1 (16.6, 26.4) 6.3 (4.1, 9.6) 32 12.2 (5.1, 19.2) 104 16.0 (15.1, 16.9)
 Vision 15.8 (14.4, 17.4) 4.4 (3.5, 5.5) 144 14.9 (12.1, 17.6) 507 16.5 (16.1, 16.8)
Any tobacco
 No disability 56.6 (56.0, 57.2) 27.3 (26.9, 27.7) d d d d
 Any 61.2 (60.0, 62.4) 34.5 (33.1, 35.9) d d d d
 Cognitive 62.6 (60.8, 64.4) 36.3 (34.5, 38.2) d d d d
 Hearing 63.8 (61.0, 66.5) 39.2 (36.5, 42.0) d d d d
 IL 61.0 (59.0, 63.0) 34.1 (31.9, 36.4) d d d d
 Mobility 59.0 (54.5, 63.3) 36.0 (32.4, 39.9) d d d d
 Self-care 56.4 (50.3, 62.3) 36.9 (31.5, 42.6) d d d d
 Vision 59.0 (56.3, 61.7) 32.9 (30.9, 34.9) d d d d
Alcohol
 No disability 80.9 (80.5, 81.3) 56.9 (56.3, 57.6) 32,473 6.6 (6.5, 6.6) 46,837 16.8 (16.8, 16.8)
 Any 80.6 (79.7, 81.4) 52.9 (51.6, 54.2) 6,370 6.7 (6.4, 6.9) 9,789 16.3 (16.2, 16.4)
 Cognitive 81.4 (80.2, 82.6) 54.0 (52.3, 55.8) 4,230 6.8 (6.5, 7.0) 6,411 16.2 (16.2, 16.3)
 Hearing 78.4 (75.2, 81.2) 50.5 (46.9, 54.1) 594 6.9 (6.1, 7.7) 940 16.1 (15.8, 16.3)
 IL 79.8 (77.8, 81.6) 50.9 (48.5, 53.3) 1,746 6.5 (6.0, 6.9) 2,781 16.2 (16.0, 16.4)
 Mobility 75.4 (71.4, 78.9) 45.7 (42.0, 49.4) 517 6.1 (5.4, 6.8) 854 16.2 (15.9, 16.5)
 Self-care 70.4 (65.6, 74.8) 42.3 (36.9, 48.0) 204 6.6 (5.1, 8.0) 349 15.6 (15.1, 16.1)
 Vision 79.3 (76.9, 81.5) 50.8 (48.3, 53.3) 1,446 6.2 (5.8, 6.6) 2,317 16.4 (16.3, 16.6)
Marijuana
 No disability 50.6 (49.9, 51.3) 20.2 (19.9, 20.5) 11,477 14.7 (14.4, 15.0) 29,268 16.6 (16.5, 16.6)
 Any 58.8 (57.6, 60.0) 27.7 (26.7, 28.7) 3,404 16.0 (15.5, 16.5) 7,300 16.1 (16.1, 16.2)
 Cognitive 61.6 (59.8, 63.4) 29.5 (28.1, 30.8) 2,342 16.0 (15.4, 16.6) 4,939 16.1 (16.0, 16.2)
 Hearing 54.6 (50.9, 58.2) 26.2 (23.3, 29.5) 321 17.2 (15.7, 18.8) 676 15.9 (15.6, 16.1)
 IL 60.1 (58.0, 62.2) 27.2 (25.4, 29.1) 970 17.5 (16.6, 18.4) 2,152 16.1 (16.0, 16.2)
 Mobility 55.5 (51.2, 59.8) 27.1 (23.2, 31.4) 291 16.3 (14.7, 18.0) 626 15.7 (15.5, 16.0)
 Self-care 53.8 (49.3, 58.2) 24.5 (19.9, 29.6) 117 17.3 (14.3, 20.3) 269 15.4 (14.9, 15.8)
 Vision 55.0 (52.7, 57.3) 26.9 (24.8, 29.2) 778 15.3 (14.2, 16.5) 1,653 16.1 (15.9, 16.3)
Open in a new tab

Note. CI = Confidence Interval; IL = Independent Living.

a

Percentages are weighted

b

Number reflects the unweighted sample size of those who reported using the substance in the past month

c

Number reflects the unweighted sample size of those who reported ever using the substance

d

Question not asked in the survey

Implications and Contribution.

U.S. AYAs with any disability had a higher prevalence of cigarette and marijuana use and adolescents had higher alcohol prevalence than those without disabilities. Tailored substance use prevention and cessation interventions are needed to mitigate the adverse long-term consequences of substance use among young people with disabilities.

Acknowledgments:

The authors have no conflicts of interest to disclose. Effort of the authors was provided by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers U54DA036114 (JAS, JCW, LK), and R21DA051943 (ACV). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The NIH had no role in study design, data collection or analysis, or preparation and submission of the manuscript.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

  • 1.Patrick ME, Schulenberg JE, Meich RA, Johnston LD, O’Malley PM, Bachman JG. Monitoring the Future Panel Study annual report: National data on substance use among adults ages 19 to 60, 1976–2021. Monitoring the Future Monograph Series. University of Michigan Institute for Social Research: Ann Arbor, MI; 2022. doi: 10.7826/ISRUM.06.585140.002.07.0001.2022 [DOI] [Google Scholar]
  • 2.Miech RA, Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use, 1975–2021: Volume I, Secondary school students. University of Michigan Institute for Social Research: Ann Arbor, MI. https://monitoringthefuture.org/wp-content/uploads/2022/08/mtf-vol1_2021.pdf. Published 2022. Accessed December 23, 2022 [Google Scholar]
  • 3.World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization. http://whqlibdoc.wo.int/publications/2001/9241545429.pdf. Published 2001. Accessed December 20, 2022 [Google Scholar]
  • 4.Center for Behavioral Health Statistics and Quality. 2019 National Survey on Drug Use and Health: Public use file codebook. Rockville, MD: Substance Abuse and Mental Health Services Adminstration, Rockville; 2020 [Google Scholar]
  • 5.National Center for Health Statistics. Survey Description, National Health Interview Survey, 2019. Hyattsville, MD. 2020 [Google Scholar]
  • 6.WG Short Set on Functioning (WG-SS). Washington Group on Disability Statistics. Accessed July 27, 2023. https://www.washingtongroup-disability.com/question-sets/wg-short-set-on-functioning-wg-ss/ [Google Scholar]
  • 7.Cheng L, Shaewitz D The 2020 youth transition report: Outcomes for youth and young adults with disabilities. Washington, DC: Institute for Educational Leadership. https://files.eric.ed.gov/fulltext/ED615626.pdf. Published 2020. Accessed September 9, 2022 [Google Scholar]
  • 8.Trends in prevalence of disabilities among youth. US Department of Health and Human Services Office of Population Affairs. https://opa.hhs.gov/adolescent-health/physicalhealth-developing-adolescents/introduction-chronic-conditions/trends-disabilities-youth. Accessed September 9, 2022 [Google Scholar]
  • 9.Everett Jones S Lollar DJ. Relationship between physical disabilities or long-term health problems and health risk behaviors or conditions among US high school students. J Sch Health. 2008:78(5):252–257. doi: 10.1111/j.1746-1561.2008.00297.x [DOI] [PubMed] [Google Scholar]
  • 10.Nagarajan VD, Okoli CTC. A systematic review of tobacco use among adolescents with physical disabilities. Public Health. 2016;133:107–115. doi: 10.1016/j.puhe.2016.01.005 [DOI] [PubMed] [Google Scholar]
  • 11.Casseus M, Cooney JM, Wackowski OA. Tobacco use, dependence, and age of initiation among youth with cognitive disability J Pediatr. 2022;247:102–108.e8. doi: 10.1016/j.jpeds.2022.04.049 [DOI] [PubMed] [Google Scholar]
  • 12.Casseus M, Graber JM, West B, Wackowski O. Tobacco use disparities and disability among U.S. college students. J Am Coll Health. 2020:1–6. doi: 10.1080/07448481.2020.1842425 [DOI] [PubMed] [Google Scholar]
  • 13.Senders A, Horner-Johnson W. Disparities in e-cigarette and tobacco use among adolescents with disabilities. Prev Chronic Dis. 2020;17:200161. doi: 10.5888/pcd17.200161 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Barrett N, Paschos D. Alcohol-related problems in adolescents and adults with intellectual disabilities. Curr Opin Psychiatry. 2006;19(5):481–485. doi: 10.1097/01.yco.0000238474.07078.41 [DOI] [PubMed] [Google Scholar]
  • 15.Blum RW, Kelly A, Ireland M. Health-risk behaviors and protective factors among adolescents with mobility impairments and learning and emotional disabilities. J Adolesc Health. 2001;28(6):481–490. doi: 10.1016/s1054-139x(01)00201-4 [DOI] [PubMed] [Google Scholar]
  • 16.Casseus M, West B, Graber JM, Wackowski O, Cooney JM, Lee HS. Disparities in illicit drug use and disability status among a nationally representative sample of U.S. college students. Disabil Health J. 2021;14(1):100949. doi: 10.1016/j.dhjo.2020.100949 [DOI] [PubMed] [Google Scholar]
  • 17.Gimm G, Parekh T, Kitsantas P. Assessing the prevalence and risk factors of marijuana use in adults with disabilities. Addict Behav. 2023;138:107559. doi: 10.1016/j.addbeh.2022.107559 [DOI] [PubMed] [Google Scholar]
  • 18.Center for Behavioral Health Statistics and Quality. 2015 National Survey on Drug Use and Health (NSDUH): Methodological summary and definitions. Rockville, MD: Substance Abuse and Mental Health Services Adminstration, Rockville; 2016 [Google Scholar]
  • 19.R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; 2022. https://www.R-project.org/ [Google Scholar]
  • 20.Lumley T Analysis of complex survey samples. J Stat Softw. 2004;9(1):1–19. doi: 10.18637/jss.v009.i08 [DOI] [Google Scholar]
  • 21.Lang JA. _interactions: Comprehensive, user-friendly toolkit for probing interactions_. R package version 1.1.0. https://cran.r-project.org/package=interactions
  • 22.Schulz JA, Parker MA, Villanti AC. Trends in cigarette smoking prevalence and status among U.S. adults with disabilities, 2015–2019. Drug Alcohol Depend. 2023;243:109738. doi: 10.1016/j.drugalcdep.2022.109739 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Branstetter SA, Mercincavage M, Muscat JE. Predictors of the nicotine dependence behavior time to first cigarette in a multiracial cohort. Nicotine Tob Res. 2015;17(7):819–824. doi: 10.1093/ntr/ntu236 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing tobacco use among adolescent and young adults: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention. https://www.ncbi.nlm.nih.gov/books/NBK99237/. Published 2012. Accessed September 29, 2022 [PubMed] [Google Scholar]
  • 25.Fergusson DM, Horwood LJ, Beautrais AL. Cannabis and educational achievement. Addiction. 2003;98(12):1681–1692. doi: 10.1111/j.1360-0443.2003.00573.x [DOI] [PubMed] [Google Scholar]
  • 26.Dorard G, Berthoz S, Phan O, Corcos M, Bungener C. Affect dysregulation in cannabis abusers: A study in adolescents and young adults. Eur Child Adolesc Psychiatry. 2008;17(5):274–282. doi: 10.1007/s00787-007-0663-7 [DOI] [PubMed] [Google Scholar]
  • 27.DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age of first alcohol use: A risk factor for the development of alcohol disorders. Am J Psychiatry. 2000;157(5):745–750. doi: 10.1176/appi.ajp.157.5.745 [DOI] [PubMed] [Google Scholar]
  • 28.Emerson E, Turnbull L. Self-reported smoking and alcohol use among adolescents with intellectual disabilities. J Intellect Disabil. 2005;9(1):58–69. doi: 10.1177/1744629505049730 [DOI] [PubMed] [Google Scholar]
  • 29.Robertson J, Emerson E, Baines S, Hatton, C. Self-reported smoking, alcohol and drug use among adolescents and young adults with and without mild to moderate intellectual disability. J Intellect Dev Disabil. 2018;45(1):1–11. doi: 10.3109/13668250.2018.1440773 [DOI] [Google Scholar]
  • 30.Haffajee RL, Mauri A. Cannabis legalization in the US: Population health impacts. Health Affairs Health Policy Brief. 2021. doi: 10.1377/hpb20210701.500845 [DOI] [Google Scholar]
  • 31.Oetting ER, Donnermeyer JF. Primary socialization theory: The etiology of drug use and deviance. I. Subst Use Misuse. 1998;33(4):995–1026. doi: 10.3109/10826089809056252 [DOI] [PubMed] [Google Scholar]
  • 32.Niaura RS, Villanti AC. Tobacco Use. In: Brown BB, Prinstein MJ, eds. Encyclopedia of Adolescence. Vol. 3. San Diego: Academic Press. 2011:331–337 [Google Scholar]
  • 33.Maxey M, Beckert TE. Adolescents with disabilities. Adolesc Res Rev. 2017;2:59–75. doi: 10.1007/s40894-016-0043-y [DOI] [Google Scholar]
  • 34.Pacoricona Alfaro DL, Ehlinger V, Spilka S, Ross J, Sentenac M, Godeau E. Alcohol tobacco and cannabis use: Do students with mild-intellectual disability mimic students in the general population? Res Dev Disabil. 2017;63:118–131. doi: 10.1016/j.ridd.2016.10.009 [DOI] [PubMed] [Google Scholar]
  • 35.Berberian S Patock-Peckham JA, Guarino K, Gupta T, Sanabria F, Infurna F. Does loneliness before the age of twelve indirectly affect impaired control over drinking, alcohol use, and problems through perceived stress? Addict Behav Rep. 2022;16:100448. doi: 10.1016/j.abrep.2022.100448 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.McKay MT, Konowalczyk S. Andretta JR, Cole JC. The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom. Addict Behav Rep. 2017;6:65–70. doi: 10.1016/j.abrep.2017.07.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Ullmann H, Weeks JD, Madans JH. Stressful life events among children aged 5–17 years by disability status: United States, 2019. NCHS Data Brief. 2022;431:1–8. doi: 10.15620/cdc:112970 [DOI] [PubMed] [Google Scholar]
  • 38.Enoch M-A. The role of early life stress as a predictor for alcohol and drug dependence. Psychopharmacology (Berl). 2011;214(1):17–31. doi: 10.1007/s00213-010-1916-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Keyes KM, Hatzenbuehler ML, Hasin DS. Stressful life experiences, alcohol consumption, and alcohol use disorders: The epidemiologic evidence for four main types of stressors. Pscyhopharmacology (Berl). 2011;218(1):1–17. doi: 10.1007/s00213-011-2236-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C. Adolescence and the social determinants of health. Lancet. 2012;379(9826):1641–1652. doi: 10.1016/S0140-6736(12)60149-4 [DOI] [PubMed] [Google Scholar]
  • 41.Iezzoni LI. Eliminating health and health care disparities among the growing population of people with disabilities. Health Aff (Millwood). 2011;30(10):1947–1954. doi: 10.1377/hlthaff.2011.0613 [DOI] [PubMed] [Google Scholar]
  • 42.Okoro CAH, NaTasha D, Cyrus AC, Griffin-Blake S. Prevalence of disability and health care access by disability status and type among adults–United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:882–887. doi: 10.15585/mmwr.mm6732a3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Houtenville A, Shreya P, Rafal M. Annual report on people with disabilities in America: 2021. Durham, NH: University of New Hampshire, Institute on Disability; 2022 [Google Scholar]
  • 44.World Health Organization. World report on disability. Geneva: World Health Organization; 2011. [Google Scholar]
  • 45.Center for Behavioral Health Statistics and Quality. 2020 National Survey on Drug Use and Health (NSDUH): Methodological summary and definitions. Rockville, MD: Substance Abuse and Mental Health Services Adminstration, Rockville; 2021 [Google Scholar]
  • 46.US Department of Health and Human Services. Final data collection standards for race, ethnicity, primary language, sex, and disability status required by section 4302 of the Affordable Care Act, October 31, 2011. Available at: http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=53. Accessed November 17, 2022
  • 47.Screening for substance use in the pediatric/adolescent medicine setting. National Institute on Drug Abuse. https://nida.nih.gov/nidamed-medical-healthprofessionals/science-to-medicine/screening-substance-use/in-pediatric-adolescent-medicine-setting. Published May 3, 2021. Accessed May 26, 2023. [Google Scholar]
  • 48.Iezzoni LI, Rao SR, Ressalam J, et al. Physicians’ perceptions of people with disability and their health care. Health Aff (Millwood). 2021;40(2):297–306. doi: 10.1377/hlthaff.2020.01452 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Lagu T, Haywood C, Reimold K, DeJong C, Sterling RW, Iezzoni LI. ‘I am not the doctor for you’: Physicians’ attitudes about caring for people with disabilities. Health Aff (Millwood). 2022;41(10):1387–1395. doi: 10.1377/hlthaff.2022.00475 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Kerr S, Lawrence M, Darbyshire C, Middleton AR, Fitzsimmons L. Tobacco and alcohol-related interventions for people with mild/moderate intellectual disabilities: A systematic review of the literature. J Intellect Disabil Res. 2013;57(5):393–408. doi: 10.1111/j.1365-2788.2012.01543.x [DOI] [PubMed] [Google Scholar]
  • 51.Kiewik M, VanDerNagel JEL, Engels RCME, DeJong CA. The efficacy of an e-learning prevention program for substance use among adolescents with intellectual disabilities: A pilot study. Res Dev Disabil. 2017;63:160–166. doi: 10.1016/j.ridd.2016.09.021 [DOI] [PubMed] [Google Scholar]
  • 52.Kiewik M, VanDerNagel JEL, Kemna LEM, Engels RCME, DeJong CAJ. Substance use prevention program for adolescents with intellectual disabilities on special education schools: a cluster randomized control trial. J Intellect Disabil Res. 2016;60(3):191–200. doi: 10.1111/jir.12235 [DOI] [PubMed] [Google Scholar]
  • 53.Green DM, Lewis H, Vogt S. Prevention of tobacco use in youth with disabilities: A video experimental model. J Public Health Issues Pract. 2020;4(2):168. doi: 10.33790/jphip1100168 [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

1
NIHMS1936485-supplement-1.docx (1.2MB, docx)

RESOURCES