“Although few tobacco control efforts target individuals with intellectual and/or developmental disabilities, this population may be especially vulnerable to the deleterious effects of tobacco use and dependence."1
Tobacco Use and Disability
Tobacco use in individuals with any form of disability is in fact at a higher rate than the general population, with a rate of 25% as compared to the general population at 15%.2 This disparity may increase the difficulties that those with disability already face. Research on tobacco use in those with intellectual and developmental disabilities (IDDs) is unfortunately lacking, and as such there have been no large-scale studies for this population.
Why is smoking a particular concern for individuals with Intellectual and/or Developmental Disabilities?
Individuals with IDDs are even more vulnerable to the harmful effects of tobacco use than the general population. The health and financial effects of tobacco use are still present, but individuals with IDDs might be less capable to cope with these effects than the general population.
Unfortunately, this is compounded further by the fact that many healthcare professionals overlook their patients with IDDs as being a smoking prevalent population. Doctors are less likely to advise patients with IDDs to quit smoking, most likely because they overlook the possibility that these individuals might be smoking or are pre-occupied by the individual's specific disability.2
Individuals with IDDs may be even more apt to begin smoking than those in the general population, as they may be less capable than others of understanding the risks of tobacco use or dealing with any pressure to begin smoking. This also means that individuals with IDDs will have a more difficult time quitting smoking for some of the same reasons.
The Health Risks of Tobacco Use among those with IDDs
Individuals with IDDs may be even more prone to health risks from tobacco use than the general population. The most common causes of death for individuals with IDDs are respiratory illness, cardiovascular disease and cancer, each of which can be caused by smoking or exposure to tobacco smoke.
Individuals with IDDs and comorbid substance use disorders smoke at tremendously high rates – 83%-- and are still less capable to deal with the potential health complications. This is much higher than the rate for any disability generally which is 25%.1
All of this is compounded by the fact that doctors are less likely to advise patients with IDDs on smoking cessation, than they are to advise patients within the general population.
The Financial Risks of Tobacco Use and Increased Vulnerability for those with IDDs
The financial effects of continued tobacco use can be incredibly impairing, and those with IDDs are particularly vulnerable to these effects. Adults with intellectual disabilities are three times as likely as the general population to be living in poverty, coupled with the immense costs of frequently purchasing tobacco products can create a crippling combination.2 Given the amount of SSI received by the average disabled adult and average rent prices, it is virtually impossible for a disabled person to afford housing without rental assistance.3 A pack-a-day smoker can spend upwards of $2500 a year on cigarettes, which can equal about 3-months’ worth of income for someone living off of SSI. Thus, the cost of cigarettes can have great financial impact on this population.
Treatment of Tobacco Cessation for Individuals with IDDs and Considerations
Individuals with IDDs who reside with family members are much less likely to smoke; those who do smoke tend to smoke less.2 It is possible that this is caused by the stricter rule implementation by family members who then can successfully limit the smoking of their loved ones.
Treatment for this population is unfortunately not yet fully developed. Many resources for dispensing information on tobacco cessation may not be designed so that the information is easily understandable for individuals with IDDs. One of the first steps towards developing treatment for this population will be to use treatments which are empirically supported with the general population to evaluate their effectiveness with individuals with IDDs. One such treatment manual “I Can Quit” has been developed and is publicly available online.4
The CDC provides funding to 19 State Disabilities and Health programs which aim to include people with all disabilities (not just IDDs) in health promotion activities through reduction of smoking.5 Several of these programs have initiatives connected to state quitlines in which the quitline is promoted in disabled populations, and the quitline will identify disability status. Some states have provided disability sensitivity training to quitline coaches. The New Hampshire Disability and Public Health program has developed this useful brochure for providers to help people with disabilities quit smoking.
Resources for Smoking Cessation for Individuals with IDDs
Cigarette Smoking Among Adults with Disabilities
Current Cigarette Smoking Among Adults in the United States
Smoking and People with an Intellectual Disability
CDC Funded State Disability and Health Programs
“I Can Quit” Facilitator’s Manual
Ohio Disability and Health Program
http://nisonger.osu.edu/education-training/ohio-disability-health-program/ - Focus on increasing awareness among those with disabilities of smoking cessation resources
Michigan Tobacco Quitline
New Hampshire Disability and Public Health Program
Including a smoking cessation brochure with smoking cessation tips for those with disabilities
1. Steinberg, M. L., Heimlich, L., & Williams, J. M. (2009). Tobacco Use Among Individuals With Intellectual or Developmental Disabilities: A Brief Review. Intellectual and Developmental Disabilities,47(3), 197–207. http://doi.org/10.1352/1934-9556-47.3.197
2. CDC, Cigarette Smoking Among Adults with Disabilities. Retrieved from: https://www.cdc.gov/ncbddd/disabilityandhealth/smoking-in-adults.html
3. Poverty and intellectual disability, retrieved from: https://www.mosaicinfo.org/blog-entry/poverty-and-intellectual-disability
4. I Can Quit, Facilitator’s Manual, https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Documents/IDDQuitManual.pdf
5. CDC, How to Help People with Disabilities Quit Smoking. Retrieved from: https://www.cdc.gov/features/disability-quit-smoking/index.html