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Association of Attention-Deficit/Hyperactivity Disorder Symptoms With Levels of Cigarette Smoking in a Community Sample of Adolescents

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ABSTRACT

Objective

Research on the association of attention-deficit/hyperactivity disorder (ADHD) with cigarette smoking has primarily occurred within samples of clinically referred youths. This paper reports the association of ADHD symptoms with smoking practices in a community sample of adolescents.

Method

Confidential self-report surveys were completed by 1,066 tenth-grade students enrolled in five public high schools who were taking part in a longitudinal study of biobehavioral predictors of adolescent smoking adoption. A well-standardized measure of ADHD inattention and hyperactivity-impulsivity symptoms, as well as demographic and social risk factors, were examined in relation to three levels of cigarette smoking: (1) never having smoked, (2) ever having smoked, and (3) current smoking (having smoked a cigarette within the past 30 days).

Results

Regarding lifetime cigarette use, approximately 43% of students had ever smoked. Among those who had ever smoked, approximately 31% of students were current smokers. Ever having smoked was associated with family (odds ratio [OR] = 2.49, confidence interval [CI] = 1.85, 3.36) and peer smoking (OR = 4.05, CI = 3.07, 5.33) and clinically significant ADHD inattention symptoms (OR = 3.39, CI = 1.53, 7.54). Current smoking was also associated with peer smoking (OR = 2.99, CI = 1.72, 5.20) and clinically significant ADHD inattention symptoms (OR = 2.80, CI = 1.20, 6.56).

Conclusion

Clinically significant ADHD symptoms should be taken into account when identifying adolescents at risk to smoke, since those with problematic inattention may be more likely to experiment with smoking and to become regular tobacco users.

Section snippets

Sample

Longitudinal Cohort. The research cohort comprised 1,136 tenth-grade students (52% male, 48% female) enrolled in five public high schools in northern Virginia who were being followed for 4 years (9th–12th grade) to evaluate social, psychological, and genetic predictors of adolescent smoking adoption. Students were ineligible to participate if they had a special classroom placement (i.e., severe learning disability and/or English as a second language) that might preclude valid survey

Characteristics of Study Participants

The characteristics of the study sample are shown in Table 1. Fifty-two percent were female, and 65% were white. Regarding smoking, 43% (n = 457) were ever smokers; among those who had ever tried smoking, 31% (n = 140) were current smokers. In terms of exposure to others who smoke, 28% were exposed through family members, and 52% were exposed through peers. Consistent with epidemiological prevalence data, clinically significant inattention symptoms only (2%, n = 21), hyperactivity-impulsivity

DISCUSSION

ADHD has been associated with smoking among clinically referred youths (Lambert and Hartsough, 1998). However, the association of ADHD symptoms with smoking in adolescent community populations is less well understood. To better identify the influence of ADHD symptoms on adolescent smoking practices, we examined clinically significant inattention and hyperactivity-impulsivity in a community sample. Of 1,066 high school sophomores surveyed, 21 (2%) met DSM-IV criteria on a validated self-report

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  • Cited by (0)

    A portion of this research was presented at the 8th Florida Conference on Child Health Psychology in Gainesville, FL (Dr. Tercyak).

    This work was supported by grant P5084718 from the National Cancer Institute and the National Institute on Drug Abuse (Dr. Lerman) .

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