Disability, Smoking and Vaping in the UK: What Our New Study Found

People with disabilities experience important health inequalities, but we still know relatively little about how disability shapes the uptake of different nicotine products. Does functional disability make people more likely to start vaping? Does it increase dual use of cigarettes and e-cigarettes? Or is the association mainly concentrated in cigarette smoking?

Our new study, published in Nicotine & Tobacco Research, examined these questions using longitudinal data from the UK Household Longitudinal Study, also known as Understanding Society.

Why this question matters

Previous research has consistently shown that cigarette smoking is more common among people with disabilities. However, much of the evidence is cross-sectional, meaning disability and tobacco use are measured at the same point in time. This makes it difficult to determine whether disability precedes nicotine-product uptake.

Evidence on e-cigarette use among people with disabilities is even more limited, particularly in the United Kingdom.

We therefore examined whether functional disability was associated with the later uptake of three nicotine-use patterns: exclusive e-cigarette use, dual cigarette and e-cigarette use, and exclusive cigarette smoking.

What we studied

We analysed data from 19,609 UK adults participating in Understanding Society. At baseline in 2018–2019, all participants were non-current users of both cigarettes and e-cigarettes. We followed them to 2022–2023.

Functional disability was assessed across 12 domains, including mobility, dexterity, hearing, sight, communication, memory and concentration, physical coordination and personal care.

Around one in four participants—4,910 people—reported at least one functional disability at baseline. At follow-up, 338 participants reported exclusive current e-cigarette use, 216 reported exclusive current cigarette smoking, and 61 reported dual use.

What did we find?

Functional disability was not associated with subsequent exclusive e-cigarette use after adjustment for age, sex, education, ethnicity, urban or rural residence, and country of residence.

We also found no statistically significant association between functional disability and dual cigarette–e-cigarette use, although the number of dual users was small and these estimates should be interpreted cautiously.

The pattern for cigarette smoking was different. Functional disability was associated with a higher relative likelihood of later exclusive cigarette smoking, with an adjusted relative risk ratio (RRR) of 1.41 compared with adults without a functional disability.

The association was stronger among people reporting two or more disability domains. Compared with adults reporting no disability domains, those with two or more had an adjusted RRR of 1.67 for exclusive cigarette smoking.

In short, disability-related differences in nicotine uptake appeared to be concentrated in combustible cigarette smoking rather than vaping.

Why might smoking and vaping differ?

There are several possible explanations, although our study was not designed to prove specific mechanisms.

People with functional limitations may face chronic stress, social isolation, reduced autonomy and barriers to preventive services that can influence smoking behaviour.

E-cigarettes may follow a different pathway. Vaping requires access to devices, charging, replacement pods or coils, and decisions about nicotine strength and product type. For some people with mobility, dexterity, sensory or cognitive impairments, these practical requirements may create barriers that are less relevant to cigarettes.

E-cigarette use has also been particularly visible among younger populations, which may partly explain why crude differences by disability changed substantially after age adjustment.

What does this mean for tobacco control?

The findings suggest that tobacco and nicotine prevention should not assume that people with disabilities have the same vulnerability to every nicotine product.

For disability-inclusive tobacco control, the priority should remain preventing combustible cigarette smoking and ensuring that smoking cessation services are accessible to people with different functional needs. Health information and cessation support should be designed for people with sensory, cognitive, communication and mobility-related impairments.

At the same time, e-cigarette uptake among people with disabilities should continue to be monitored as the UK nicotine market changes.

Health inequalities can be product-specific. Understanding who starts smoking, who starts vaping, and why those pathways differ is essential for designing more equitable tobacco-control policies.

Our study adds longitudinal UK evidence to an area dominated by cross-sectional research and shows why disability should be considered more explicitly in tobacco and nicotine research.

The paper, “E-cigarette uptake, dual use, and exclusive cigarette smoking among adults with functional disabilities: a longitudinal cohort study,” is published in Nicotine & Tobacco Research.

Yusuff Adebayo Adebisi

Pharmacist and epidemiologist advancing equity-driven, policy-relevant public health research. PhD Researcher at the University of Glasgow. Director of Research at Global Health Focus.

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