BACKGROUND-AIM:
People with intellectual disability (ID) remain significantly underrepresented in mainstream tobacco research and public health initiatives, resulting in critical knowledge and resource gaps. A deeper understanding of their smoking behaviors and the cessation support they receive is essential to developing inclusive, accessible, equitable, and effective prevention and treatment strategies. Therefore, this study aims to directly assess tobacco use and motivation to quit among adults with ID using a cross-sectional survey.

METHODS:
A total of 74 adults with ID who smoked tobacco participated in the study (27% women), aged 18–77 years (M = 46.1; SD = 13.9). Most participants had mild (59.5%) or moderate ID (36.5%), with fewer presenting severe (2.7%) or profound (1.4%) disability. A cross-sectional survey was designed and administered in Spain to evaluate tobacco use, dependence, and motivation to quit. The survey—adapted using simplified language and images—was distributed online and collected information on sociodemographic characteristics, disability level, living situation, autonomy in purchasing tobacco, smoking patterns, tobacco dependence (adapted Fagerström items), emotional triggers, cessation attempts, and motivation to quit.

RESULTS:
Nearly half of the participants (45.9%) perceived their smoking as problematic. Smoking typically began during adolescence, with 66.3% initiating between ages 14 and 18 (M = 17.9; SD = 6.5). Most (86.5%) smoked daily, and 64.9% consumed up to 10 cigarettes per day. Additionally, 20.3% reported smoking small cigars. Very few smoked when alone (17.6%), and 56.8% reported smoking more during episodes of anxiety. Relaxation (89.2%) and pleasure (78.4%) were the most frequently reported motivations for smoking. Only 18.9% expressed a desire or intention to quit. Furthermore, 48.6% believed quitting was impossible, 39.2% considered it difficult, and 31.1% feared weight gain if they stopped smoking. Previous quit attempts were reported by 45.9% of participants, generally limited to a single attempt and less than one month of abstinence. Only 18.9% received professional support: 4.1% with nicotine pills, 4.1% with a doctor or psychologist, 4.1% with both, and 2.7% used nicotine patches or gum.

CONCLUSIONS:
Adults with ID experience substantial inequities in tobacco prevention efforts and access to cessation support. The findings underscore the critical need for inclusive, evidence-based interventions tailored to this population. Strengthening the role of healthcare providers and support staff, addressing structural barriers, and promoting accessible, rights-based approaches may improve autonomy, health outcomes, and overall wellbeing. This study provides foundational data to guide future research and practical strategies to reduce disparities and enhance tobacco cessation services for this underserved group.