It has been estimated that 1.3 billion people in the world currently smoke cigarettes or tobacco related products (Guindon & Boisclair, 2003). In the United States, about 20% of the population (i.e., 43 million people) smoked cigarettes in 2007. Smoking is the most frequently occurring preventable cause of disability and death. In the United States, at least 30% of all cancer deaths are attributed to tobacco use, with smoking causing about 87% of lung cancer deaths. In addition, smoking is responsible for many non-cancerous lung diseases, such as chronic bronchitis, emphysema, and chronic obstructive pulmonary disease. Long-term smoking may also cause heart disease, aneurysms, bronchitis, emphysema and stroke, and worsen pneumonia and asthma, negatively impact the immune system, and increase the risk of sexual impotence in male smokers. Short-term smoking may result in poor lung function (which may cause shortness of breath and nagging coughs), reduced ability to smell and taste, premature aging of the skin, bad breath, and stained teeth.
The prevalence of smoking in individuals with intellectual disabilities varies widely across studies, depending on the sample size, community versus institution versus clinical samples, living arrangements, age range, gender, degree of intellectual disabilities, and comorbid mental illness. For example, in chronological order, a comprehensive sample of studies reported the following smoking prevalence rates: 7.6% in an institution and 25.6% in group homes (Rimmer, Braddock, & Marks, 1995); 36% in individuals with mild intellectual disabilities in independent community living settings (Tracy & Hosken, 1997); 18% in clinic-referred adults with severe to borderline intellectual disabilities (Hymowitz, Jaffe, Gupta & Feuerman, 1997), 4% of an adult institutional population (Peine, Darvish, Blakelock, Osborne, & Jenson, 1998); 12.7% of state and community residences in Massachusetts (Minihan, 1999); 2%, 8% and 12% of adults with intellectual disabilities residing in village communities, residential campuses, and dispersed housing in the United Kingdom (Robertson et al., 2000); 6.2% of adults attending four social services day centers (Taylor, Standen, Cutajar, Fox, & Wilson, 2004); 14% self-reported smoking in adolescents with intellectual disabilities (Emerson & Turnbull, 2005); 26% of adolescents with mild intellectual disabilities were occasional or regular smokers (Kalyva, 2007). As these studies show, smoking is a reasonably common activity for many individuals with intellectual disabilities.
Only a single published study could be located that attempted to reduce or eliminate smoking in individuals with intellectual disabilities. Peine et al. (1998) used a spinning wheel, similar to that in the Wheel of Fortune TV program, to reduce smoking by two adults in a developmental disabilities center. Prior to the intervention, if the individuals did not engage in maladaptive behavior (e.g., aggression) for an hour, they could get a cigarette. While this reduced maladaptive behavior, it resulted in high numbers of cigarettes smoked. During intervention, absence of maladaptive behavior for an hour now led to the opportunity to spin the wheel that offered various choices including cigarettes, coffee, tea, diet soda pop, diet candy, fruit juices and magazines. The probability of the spin landing on a cigarette choice reduced the opportunity to get a cigarette each hour, and this led to a 50% reduction in smoking by the end of the 3-year study.
The aim of our study was to assess the effectiveness of a mindfulness-based smoking cessation program for an individual with mild intellectual disability whose smoking had proved intractable to treatment with other approaches (e.g., nicotine replacement therapy, pharmacotherapy, etc.).
