Tobacco cessation counseling in physical therapy practice: Addressing health disparities in people with disabilities

Tobacco use is the leading preventable cause of morbidity and mortality worldwide. Smoking prevalence among American adults is estimated at 21%, with 50% higher prevalence among people with disabilities. Although many medical professionals screen for tobacco use, people with disabilities are less likely to receive tailored counseling, including specific recommendations for smoking cessation treatment options. Smokers with disabilities are also less likely to make a quit attempt, and are more likely to experience the detrimental effects of tobacco use, since smoking can exacerbate pre-existing conditions. In response to these health disparities, it is essential for professions geared towards serving the needs of people with disabilities to increase their role in promoting tobacco cessation. According to the US Medical Expenditure Panel Survey, physical therapists conduct approximately 88 million ambulatory visits, serving 9 million adults aged 18 and over, every year. The number of visits (an average of 9.6 per patient, per episode of care) and the nature of provider-patient interactions, which center around extended, personalized, one-on-one care, present a unique opportunity to provide support for smoking cessation as a means of enhancing treatment outcomes and health-related quality of life. A recent survey of physical therapy programs in the United States shows that only 25% currently include curricular content for tobacco cessation counseling. It is known that training increases the likelihood of counseling and improves provider performance. Therefore, educational change is essential in ensuring that smokers with disabilities receive appropriate intervention, facilitating more successful cessation attempts.