International Variation in Tobacco Use Among Athletes with Intellectual and Developmental Disabilities

Background and Purpose: The World Health Organization estimates that tobacco use is the leading worldwide cause of preventable death, yet more than 15% of the world’s population and approximately 25% of the world’s adult population currently uses tobacco, and global use is expected to increase. Significant efforts have been made to monitor global tobacco use and trends, but little is known about national or international prevalence rates of tobacco use among people with intellectual and developmental disabilities (IDD). Since this population is at increased risk of health problems, this study aims to fill a critical knowledge gap by examining tobacco use prevalence rates among a large sample of people with IDD.

Methods: The Special Olympics International (SOI) Health Promotion database provided data on 43,812 athletes with IDD who participated in free health screenings in seven world regions (Africa [n=2,059], Asia-Pacific [n=1,582], East Asia [n=3,961], Europe [n=10,453], Latin America [n=7,506], Middle East [n=1,020], and North America [n=17,231]) between 2007 and 2013. Participants were aged 16-97 (M=27.10), and 51% were male. Tobacco use rates were examined by region and a one-way ANOVA with random effects was used to determine whether world regions vary in their tobacco use rates.

Results:  Overall, 8.33% of the sample of Special Olympians used tobacco products compared to approximately 25% of adults worldwide. Tobacco use rates for these individuals with IDD were 17.38% for Europe, 7.35% for East Asia, 6.45% for Asia-Pacific, 5.87% for North America, 5.25% for Africa, 5.00% for the Middle East, and 3.60% for Latin America.  The one-way ANOVA with random effects confirmed significant between-group variation in tobacco use by region (χ²(6)=1651.669, p<.001). 

Conclusions and Implications: Tobacco use among athletes with IDD varies significantly by world region with Europe having the highest rate and Latin America having the lowest. Although athletes with IDD have a lower tobacco use rate than the population as a whole, consequences for this population may be higher. People with IDD may already have health problems related to their disability, and tobacco use may lead to increased risk of shortened lifespan. As people with IDD experience improved opportunities for inclusion in society, their financial and social independence will increase, allowing them to engage more freely in health risk-taking behaviors, such as tobacco use. They may also be more vulnerable to social pressures associated with engaging in health risk-taking behaviors. People with IDD should be educated about the health risks of tobacco use, prepared to avoid tobacco use, and helped to stop if they use tobacco. Given that this study’s sample size far exceeds that of the few prior studies of tobacco use among people with IDD, results can be used to inform such efforts. As one of the major professional groups assisting people with IDD, social workers have important opportunities to develop tobacco use prevention efforts tailored not only for individuals of differing cognitive abilities but also for differing cultural groups.