Higher nicotine consumption observed among youth with attention-deficit hyperactivity disorder

1. This cohort of United States youths with asymptomatic attention-deficit hyperactivity disorder (ADHD), did not have statistically significant differences in their odds of starting nicotine or tobacco products compared with the control group. 

2. The youths with more ADHD symptoms had a greater likelihood of starting nicotine or tobacco products compared to the control group.

Evidence Rating Level: 2 (Good) 

Study Rundown: Tobacco use is the leading cause of preventable death worldwide. The relationship between tobacco and attention-deficit/hyperactivity disorder (ADHD) has been well established although changing over time. Features of ADHD include functional impairment, lack of attention, and possibly hyperactivity. This cohort study aimed to find additional research regarding the association between tobacco use and ADHD. Included in the cohort were children aged 12 to 17 years old along with their parents, from baseline in September 2013 to April 2023. The key outcome of interest was the new onset of 4 nicotine or tobacco use among youths who reported no lifetime use at baseline. The parent participants reported if their child had been diagnosed with ADHD or ADD, and if so, were they taking regular medication. The youth completed questions from the Global Appraisal of Individual Needs (GAIN) assessment including a list of symptoms listed on the PhenX Toolkit. When compared to the control group, individuals with asymptomatic ADHD did not significantly differ in the likelihood of initiating cigarette use, dual use, or other tobacco use throughout the study period. On the other hand, youth with symptomatic ADHD had a greater chance of starting nicotine or tobacco products during the study period. This study included individuals 12 years of age and older, however, some youths had already initiated nicotine or tobacco by this age. Future research should aim to evaluate ADHD symptoms corresponding with nicotine and tobacco use earlier. Overall, the study findings highlight the importance of early ADHD diagnosis and treatment in youths to prevent future nicotine and tobacco use. 

Click here to read the study in JAMA Network Open 

Relevant reading: Association between e-cigarette use and parents’ report of attention deficit hyperactivity disorder among US youth 

In-Depth [retrospective cohort]: This cohort study was conducted with youth in the US to determine the relationship between ADHD symptoms and nicotine and tobacco initiation. The youth and their parents received surveys at baseline and follow-up waves. Each survey was completed through audio computer-assisted self-interviews. At each interview, the participants were asked to report on lifetime and past-year use of 9 nicotine or tobacco products. The total sample included 13 572 youths in the US, with 6972 (50.4%; 95% CI, 50.3%-50.6%) between 12 and 14 years of age, and 6600 (49.6%; 95% CI, 49.4%-49.7%) between 15 to 17 years of age. Of the total population, 1881 youths were diagnosed with ADHD (14.1%; 95% CI, 13.2%-15.0%), and 1074 of them (57.9%; 95% CI, 55.2%-60.5%) received pharmacotherapy at baseline. The youths who reported more ADHD symptoms also had a higher prevalence and incidence of using nicotine and tobacco products. The asymptomatic ADHD group and the control group did not have significantly different odds of incident nicotine or tobacco use, including e-cigarette use. Comparatively, in ADHD groups with three or more symptoms of the diagnosis, there were higher adjusted odds for tobacco use (adjusted odds ratio (AOR), 1.61; 95% CI, 1.27-2.02) and nicotine use, such as e-cigarette use (AOR, 1.60; 95% CI, 1.34-2.04), and cigarette use (AOR, 1.52; 95% CI, 1.22-1.89) compared to the control group. There was a significantly higher likelihood of starting e-cigarettes (AOR, 1.68; 95% CI, 1.16-2.44) and dual use (AOR, 1.82; 95% CI, 1.17-2.83) in youths with ADHD and 3 or more symptoms receiving pharmacotherapy, compared with youths with asymptomatic ADHD receiving pharmacotherapy. Overall, the likelihood of initiating tobacco or nicotine use did not significantly differ between youth with asymptomatic ADHD and the control group. However, there were significantly higher odds of initiating these products in the symptomatic ADHD youth compared to the control. 

Image: PD 

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