"Research on tobacco use among individuals with IDD is limited and presents a disparity in research that needs to be addressed."3
Tobacco Use and Disability
Growing attention has focused on prevention and smoking cessation efforts among a variety of marginalized populations, yet often overlooks those living specifically with an Intellectual or Developmental Disability (IDD). Tobacco use among individuals living with any form of disability has been estimated to be 27.8%, a much higher figure than tobacco use among the general population estimated at 3.4%1 with lower rates in IDD populations (7%).2 Research on tobacco use among individuals with IDD is limited and presents a disparity in research that needs to be addressed.3
Why is smoking a particular concern for individuals with Intellectual and/or Developmental Disabilities?
Individuals with IDDs are more vulnerable to the harmful effects of tobacco use than the general population, as they tend to have higher rates of chronic health conditions known to be affected by tobacco use such as cancer, diabetes, respiratory, and cardiovascular issues.3 This population also tends to have less access to health care services and primary prevention efforts such as health promotion and education campaigns.3 This lack of access deprives people with IDDs of critical interventions and information that allow them to make informed decisions regarding tobacco use.3
Healthcare professionals often overlook smoking behavior in patients with IDDs and overly attribute symptoms of health conditions to the patient’s disability.3 Additionally, those with more severe cases of IDD may be unable to verbalize symptoms they are experiencing, furthering underdiagnoses of health conditions.4 This underdiagnoses along with a disproportionate focus on a patient’s disability leads to missed opportunities to address health risk behaviors such as smoking with IDD patients.3,4
The Health Risks of Tobacco Use among those with IDDs
Individuals with IDDs may be even more prone to health risks from cigarette smoking than the general population.1,3,5 It is estimated that people with IDD live 20 years less than the general population, largely thought to be due to increased acquisition rates and complications from comorbid chronic health conditions.3 The most common causes of death for individuals with IDDs are respiratory illness, cardiovascular disease, and neoplasms (including cancer), each of which can be caused and/or worsened by smoking or exposure to tobacco smoke.3,5,6
Compared to nonsmokers, those who smoke and have comorbid psychiatric conditions are four times more likely to die prematurely, with a 5-year decrease in their overall life expectancy.6 While 7% of individuals with an IDD use tobacco, the rate of tobacco use among those with IDD who have a comorbid psychiatric disorder (mood, anxiety, psychotic and/or other mental illness) is elevated to10%.2
These risks are all 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.4
The Financial Risks of Tobacco Use and Increased Vulnerability for those with Disabilities
Disabled persons in the US live in poverty at twice the rate of non-disabled persons.7 Individuals with IDD who collect Social Security Income (SSI) as their single source of income make up 21.9% of all SSI recipients.8 Given the amount of Social Security Income received by the average single disabled adult ($783 as of 2020)9 and average national rent prices ($1,023 as of 2018),10 it is virtually impossible for a disabled person living solely on SSI to afford housing without rental assistance.
The cost of cigarettes can also be quite substantial, with those collecting income solely from state benefit programs most at risk. For example, the price of a pack of cigarettes on average is $6.28 in the US.9 A person who smokes a pack a day will spend on average around $2,292 a year on cigarettes,9 which is only $57 short of 3-months ($2349) of income for someone living solely off SSI. Thus, the cost of cigarettes can have great financial impact on this population.
Treatment of Tobacco Cessation for Individuals with IDDs and Considerations
It’s been found that smokers with IDDs living in group homes tend to smoke 30-40 cigarettes per day and those who reside with family members or in highly monitored institutions tend to smoke less.12 This is possibly caused by the stricter rule implementation and oversight from family members and staff in comparison to the less rigid rule implementation in a group home.12
Treatment for this population is unfortunately not yet fully developed. Many resources for dispensing information on tobacco cessation may not be designed to be easily understood by individuals with IDDs. A current suggestion in the literature is to have graphic or pictorial warning labels which can be more easily understood by individuals with difficultly reading or reading comprehension.13 One of the first steps towards developing treatment for this population will be to use treatments which have empirical efficacy amongst the general population and then to evaluate their effectiveness with individuals with IDDs.
The CDC provides funding to 19 State Disabilities and Health programs that aim to include people with all disabilities (not just IDDs) in health promotion activities through reduction of smoking.1 Several of these programs have initiatives connected to state Quitlines.
Resources and Information on Smoking and Smoking Cessation for Individuals with IDDs
Centers for Disease Control and Prevention
- Cigarette Smoking Among Adults with Disabilities
- Current Cigarette Smoking Among Adults in the United States
- CDC Funded State Disability and Health Programs
MONASH University - “I Can Quit” Facilitator’s Manual
Maryland Department of Disabilities – Services for People with Disabilities
Institute of Disability (University of New Hampshire) – Smoking Cessation and Disability
Ohio State University – Quit Smoking – for people with disabilities
- CDC, Cigarette Smoking Among Adults with Disabilities. Retrieved from: https://www.cdc.gov/ncbddd/disabilityandhealth/smoking-in-adults.html
- National Core Indicators. Chart Generator 2017-18. National Association of State Directors of Developmental Disabilities Services and Human Services Research Institute. Retrieved on 08/23/2020 from the National Core Indicators Website: http://www.nationalcoreindicators.org/charts/
- Eisenbaum E. (2018). Tobacco product use and smoking frequency among US adults with intellectual and developmental disabilities. Journal of intellectual disability research : JIDR, 62(8), 709–718. https://doi.org/10.1111/jir.12507
- May, M. E., & Kennedy, C. H. (2010). Health and problem behavior among people with intellectual disabilities. Behavior analysis in practice, 3(2), 4–12. https://doi.org/10.1007/BF03391759
- Stankiewicz, E., Ouellette-Kuntz, H., McIsaac, M., Shooshtari, S., & Balogh, R. (2018). Patterns of mortality among adults with intellectual and developmental disabilities in Ontario. Canadian journal of public health = Revue canadienne de sante publique, 109(5-6), 866–872. https://doi.org/10.17269/s41997-018-0124-8
- Centers for Disease Control and Prevention, Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions. (2020, February 04). Retrieved August 27, 2020, from https://www.cdc.gov/tobacco/disparities/mental-illness-substance-use/index.htm
- Highlighting Disability / Poverty Connection, NCD Urges Congress to Alter Federal Policies that Disadvantage People with Disabilities. (2017, November 13). Retrieved August 27, 2020, from https://ncd.gov/newsroom/2017/disability-poverty-connection-2017-progress-report-release
- Livermore G. A., Bardos M., & Katz K (2017). Supplemental Security Income and Social Security Disability Insurance Beneficiaries with Intellectual Disability, Social Security Bulletin, from https://www.ssa.gov/policy/docs/ssb/v77n1/v77n1p17.html
- SSI Federal Payment Amounts For 2020. (2020). Retrieved September 01, 2020, from https://www.ssa.gov/oact/cola/SSI.html
- U.S. Census Bureau (2018). American Community Survey Narrative Profiles. from https://www.census.gov/acs/www/data/data-tables-and-tools/narrative-profiles/2018/report.php?geotype=nation
- National Cancer Institute. "How Much Will You Save?" https://smokefree.gov/quit-smoking/why-you-should-quit/how-much-will-you-save. Accessed August 27, 2020
- 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. https://doi.org/10.1352/1934-9556-47.3.197
- Rubinstein, M. L. (2015). Scanning the brain for answers about effectiveness of graphic warning labels. Tobacco Control, 24 (211-212). http://dx.doi.org.proxy-um.researchport.umd.edu/10.1136/tobaccocontrol-2...