BACKGROUND Tobacco use is closely linked to social and health inequalities, including economic vulnerability, morbidity, and premature death. Young adults with disabilities experience significant social and material hardships, which may be exacerbated by tobacco use. Limited research exists on smoking and e-cigarette use in this population. This study examines the prevalence of disability among young adults in Ireland, compares smoking and e-cigarette use between those with and without disabilities, identifies protective and risk factors, explores shared risk factors, and evaluates disability as an independent risk factor for smoking and e-cigarette use.

METHODS We analysed weighted data from 4,729 20-year-olds in the Growing Up in Ireland Cohort '98 study who were present in Waves 1 (2008), 3 (2016), and 4 (2019). Current smoking, e-cigarette use, disability (excluding mental ill-health) and all other variables were assessed at Wave 4, while peer smoking data were drawn from Wave 3. Analyses were conducted using SPSS version 27.

RESULTS 18.1% of participants reported a disability, which was associated with significantly higher smoking (41.8% vs. 36.7%) and e-cigarette use (16.1% vs. 12.9%). Protective factors against both behaviours included being female (OR 0.87 for smoking, OR 0.57 for e-cigarettes), later smoking initiation (OR 0.35, OR 0.62), living in two-parent families (OR 0.83, OR 0.70), and physical activity (smoking only). Risk factors included having peers who smoked (OR 3.67 for smoking; OR 2.36 for e-cigarette use) and caregivers who smoked (OR 1.48, OR 1.48), being employed at age 20 (OR 1.58, OR 1.48), and social media engagement (smoking only). Young adults with disabilities were significantly more likely to experience risk factors (e.g., earlier smoking initiation, caregivers who smoked, one-parent families, employment) but were less likely to have peers who smoked or engage with social media. Disability was independently associated with a higher likelihood of smoking (by 54%) and e-cigarette use (by 36%) after adjusting for protective and risk factors.

CONCLUSION Higher smoking and e-cigarette use in 20-year-olds with disabilities adds further inequality to their lives. Increased awareness, targeted surveys and focused prevention and therapeutic interventions are required to reduce inequalities in this population and hasten the tobacco endgame.