Understanding cigarette smoking and cessation among adults with intellectual disability in residential services: A multiperspective study

Abstract

Background: Cigarette smoking is prevalent among adults with intellectual disability (ID), yet much remains to be understood about their smoking and cessation experiences, contributing to ongoing healthcare inequalities. This study aims to understand smoking experiences and cessation barriers and facilitators among people with ID in residential services, using a multiperspective approach.

Methods: This qualitative study involved 10 adults with ID who smoked cigarettes daily and 10 support professionals purposively recruited from residential services. In-depth face-to-face interviews were conducted to explore experiences of tobacco use and cessation. Data were analyzed using Interpretative Phenomenological Analysis.

Results: Six superordinate themes emerged: (1) smoking initiation as a social behavior and identity construction; (2) current smoking as a daily routine, shared activity, and source of gratification; (3) access to cigarettes and smoking regulation by support professionals; (4) ambivalent motivation to quit, with health concerns as transient triggers; (5) cessation barriers, including risk minimization, social influences, low self-efficacy, and limited knowledge of interventions; and (6) perceived cessation aids, including distraction and social support. Certain support practices-i.e., restricting access to cigarettes or using them as a reward-were experienced as limiting, underscoring tensions between health promotion and autonomy.

Conclusions: Findings highlight the need for rights-based, person-centered cessation approaches for people with ID. Cessation strategies should extend beyond pharmacology to include emotional, social, and environmental dimensions, while aligning with individuals' values and experiences. Professionals require training to balance health promotion with self-determination. Future interventions should prioritize empowerment and provide tailored, evidence-based support addressing personal and contextual factors.

Keywords: Addictive behavior; Inclusive research; Intellectual developmental disorder; Interpretative phenomenological analysis; Qualitative; Residential context; Tobacco.