Severity of Disability-Related Functional Difficulties and Tobacco Use Patterns in a National Sample of U.S. Veterans

INTRODUCTION: Veterans are more likely than non-veterans to report disability and to use tobacco products. Although prior research has linked disability status and related functional difficulties with tobacco use in the general population, research among veterans is limited. METHODS: The sample included 10,542 U.S. military veterans who completed the 2020-2023 National Health Interview Survey. Tobacco use was categorized as non-use, single-product use, or poly-tobacco use. Functional difficulties were measured in NHIS using the Washington Group Short Set and categorized as no, some, or significant difficulties. Binary and multinomial logistic regression models adjusted for relevant sociodemographic covariates. RESULTS: Veterans with some functional difficulties had higher odds of cigarette, e-cigarette, and pipe use compared with those reporting no difficulties (AORs 1.35-1.90), whereas veterans with significant functional difficulties had more than twice the odds of such product use. Veterans with some or significant functional difficulties were at higher relative risk of poly-tobacco use (vs. non-use), and significant difficulties were associated with higher relative risk of poly-tobacco use (vs single-product use) relative to those with no difficulties. Compared with veterans reporting some difficulties, those with significant difficulties had higher odds of cigarette (AOR = 1.49) and e-cigarette use (AOR = 1.54), and higher relative risk of poly-tobacco use (vs non-use: RRR = 1.74; vs single-product use: RRR = 1.50). CONCLUSIONS: Results indicated a graded association between severity of disability-related functional difficulties and tobacco use patterns among veterans. Future research should develop and test tobacco cessation interventions tailored to veterans with varying levels of disability-related functional difficulties. IMPLICATIONS: The results provide evidence that greater severity of disability-related functional difficulties is associated with higher odds of both single-tobacco and poly-tobacco product use among U.S. military veterans. Veterans with more severe functional limitations may be particularly vulnerable to poly-tobacco use, which may place such veterans at heightened risk for tobacco-related harms. Findings underscore the utility of incorporating assessment of disability-related functional difficulties into tobacco risk screening and developing accessible, tailored cessation interventions for veterans who experience varying levels of functional impairment.