Tobacco Use Among People with Intellectual and Developmental Disabilities: Prevalence and Predictors in a National Sample of Special Olympians

Background/ Purpose: In the U.S., the CDC estimates that 17.8% of adults smoke and that cigarette smoking is responsible for more than 480,000 deaths per year, or 1,300 deaths per day. Significant efforts have been made to monitor tobacco use and trends, but little is known about prevalence and predictors of tobacco use among people with intellectual and developmental disabilities (IDD). 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 both healthy behaviors, and health risk behaviors, such as tobacco use. This study aims to fill a critical knowledge gap by examining prevalence and predictors of tobacco use among a large sample of people with IDD in the United States.

Methods: We used data from 4,462 athletes with IDD who participated in free Special Olympics health screenings throughout the United States between 2007 and 2013. Participants were aged 16-92 (M=32.33), and 55.2% were male. A stepwise logistic regression was used to test whether gender, age, body mass index, systolic blood pressure, diastolic blood pressure, family smoking history, and fruit and vegetable consumption predict tobacco use in adult athletes with IDD.

Results: Of all Special Olympians in the sample, 309 (6.93%) reported using tobacco and 4,153 (93.07%) reported not using tobacco. Results indicated that female athletes were 236% more likely than male athletes to use tobacco (B=.859, χ²(1)=40.740, p < .001, exp(B)=2.362) and that athletes who had a family history of smoking were 25% more likely to smoke (B=-1.387, χ²(1)=119.306, p < .001, exp(B)=.251). Results also indicated that for each additional year of age, athletes were approximately 100% more likely to use tobacco (B=.012, χ²(1)=4.982, p=.026, exp(B)=1.012). Body mass index, systolic blood pressure, diastolic blood pressure, and eating fruits and vegetables did not contribute significantly to the prediction of smoking. The Hosmer-Lemeshow goodness of fit statistic, χ²(8)=10.703, p=.219, indicates that there is no significant difference between the observed frequencies and expected frequencies, therefore, the model has a good fit.  

Conclusions/Implications: Results indicate that among adult athletes with IDD, women, individuals with a family history of smoking, and older individuals are more likely to use tobacco. Although athletes with IDD in the United States have a lower tobacco use rate than the general population, consequences for this population may be higher. People with IDD experience chronic diseases and conditions at higher rates than those without disabilities. Tobacco use may compound existing health complications and lead to increased risk of morbidity and mortality. Current education efforts focused on the risks of tobacco use often fail to include people with IDD. Results of this study can be used to inform creation of targeted prevention and cessation efforts. Further examination of predictors of tobacco use is needed to better identify those who could be targeted for intervention efforts, and to determine the longitudinal effects of tobacco use on individuals with IDD.