Youth With Symptomatic ADHD More Likely to Use Nicotine and Tobacco Later On
US youths with higher levels of attention-deficit/hyper activity disorder (ADHD) symptom severity had significantly higher odds of initiating e-cigarette, cigarette, and other tobacco use over a 9-year follow-up, according to a study published in JAMA Network Open.
“A major clinical implication of these findings is that health care professionals need to closely monitor inattentive and hyperactive and/or impulsive symptoms and work to reduce them to the lowest levels,” wrote corresponding author Sean Esteban McCabe, PhD, of the Center for the Study of Drugs, Alcohol, Smoking ,and Health at the University of Michigan School of Nursing, Ann Arbor, Michigan, and study coauthors.
The longitudinal study included 13,572 US youths and their parents from the Population Assessment of Tobacco and Health Study. Participants were surveyed from wave 1, which took place from September 2013 to December 2014, through 6 additional waves that ended in April 2023. Participants were aged 12 to 17 years in the first wave.
Researchers divided patients into 3 main categories: those with an ADHD diagnosis and pharmacotherapy, those with an ADHD diagnosis without pharmacotherapy, and population controls without an ADHD diagnosis. Each category was further divided by ADHD symptom severity into groups with no symptoms, 1 to 2 symptoms, or 3 to 4 symptoms.
Among the 13,572 youths in the analysis, 1881 (14.1%) had an ADHD diagnosis.
Youths with asymptomatic ADHD did not significantly differ from population controls in their odds of initiating e-cigarette use, cigarette smoking, other tobacco use, or dual use (e-cigarette and cigarette and/or other tobacco use), according to the study.
However, all subgroups with 3 or more ADHD symptoms, either with or without pharmacotherapy, had significantly higher odds compared with youths with ADHD and no symptoms or population controls. Researchers reported adjusted odds ratios of 1.60 for e-cigarette use, 1.52 for cigarette smoking, 1.61 for other tobacco use, and 1.72 for dual use.
Among youths with ADHD, adjusted odds ratios were 1.68 for e-cigarette use and 1.82 for dual use with highly symptomatic ADHD compared with asymptomatic ADHD receiving pharmacotherapy.
“Given the increased risk of nicotine and tobacco use in those with ADHD, the null findings between youths with asymptomatic ADHD and later nicotine and tobacco initiation could be interpreted as ADHD treatment being protective against subsequent nicotine and tobacco use,” researchers wrote. “Indeed, those with no ADHD diagnosis and higher ADHD symptom severity were at greater risk for nicotine and tobacco onset than youths with asymptomatic ADHD.”
Reference
