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Rhodes JD, Kennedy TM, Walther CA, Gnagy EM, Pelham WE, Molina BS. Smoking-Specific Risk Factors in Early Adulthood That Mediate Risk of Daily Smoking by Age 29 for Children with ADHD. J Atten Disord 2022; 26:525-536. [PMID: 33769107 PMCID: PMC9747070 DOI: 10.1177/10870547211003664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether smoking-specific risk factors in early adulthood mediate prediction to daily smoking from childhood ADHD. METHODS Participants were 237 with and 164 without childhood ADHD. A smoking risk profile score comprising smoking-specific factors measured between ages 18 to 25 (e.g., craving severity) and age of initiation was tested as mediator of the association between childhood ADHD and age 29 daily smoking. RESULTS Childhood ADHD predicted age 29 smoking (β = -.15, p = .019), 35% of ADHD versus 17% of nonADHD, and the profile score (β = -.07, p = .004), which in turn mediated prediction to age 29 daily smoking (β = -.03; p = .007). When tested individually, three profile variables (# cigarettes/day, difficulty concentrating during abstinence, and nicotine dependence) were significant mediators (ps = 0.005-0.038), above and beyond early adult smoking, ADHD persistence, and delinquency. CONCLUSIONS These behavioral smoking characteristics help explain later daily cigarette smoking for adults with ADHD histories and may need to be targeted in intervention.
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Xu G, Snetselaar LG, Strathearn L, Ryckman K, Nothwehr F, Torner J. Association of Attention-Deficit/Hyperactivity Disorder With E-Cigarette Use. Am J Prev Med 2021; 60:488-496. [PMID: 33745521 DOI: 10.1016/j.amepre.2020.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION E-cigarette use in young people has emerged as a public health concern in the U.S. Previous studies have shown that individuals with attention-deficit/hyperactivity disorder are more likely to use conventional cigarettes. However, little is known about their use of E-cigarettes. This study examines the association of attention-deficit/hyperactivity disorder with E-cigarette and other tobacco product use among undergraduate and graduate students in the U.S. METHODS This study included data from 195,443 U.S. undergraduate and graduate students aged 18-39 years who participated in the National College Health Assessment surveys from spring 2017 to fall 2018. History of attention-deficit/hyperactivity disorder diagnosis and current use of conventional cigarettes, E-cigarettes, and other tobacco products were ascertained by questionnaires. Logistic regression models estimated the ORs and 99% CIs of use of conventional cigarettes, E-cigarettes, and other tobacco products according to attention-deficit/hyperactivity disorder history. RESULTS Among the 195,443 students, 16,800 (8.35%) were current conventional cigarette users and 15,863 (7.89%) were current E-cigarette users; 16,283 (8.10%) had a history of attention-deficit/hyperactivity disorder diagnosis. After adjustment for demographics, socioeconomics, lifestyle factors, BMI, anxiety, and depression, the OR of E-cigarette use among participants with attention-deficit/hyperactivity disorder, compared with those without attention-deficit/hyperactivity disorder, was 1.72 (99% CI=1.60, 1.85), which was comparable to the magnitude of associations for other tobacco products. CONCLUSIONS Among U.S. undergraduate and graduate students, there is a significant association between attention-deficit/hyperactivity disorder diagnosis and current use of E-cigarettes. Health consequences of E-cigarette use among individuals with an attention-deficit/hyperactivity disorder diagnosis warrant further investigation.
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Affiliation(s)
- Guifeng Xu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Lane Strathearn
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa; Division of Developmental and Behavioral Pediatrics, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kelli Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Faryle Nothwehr
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | - James Torner
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
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3
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Hu JM, Lee CC, Lin TC, Chung CH, Chen CY, Chang PK, Hsiao CW, Sun CA, Tzeng NS, Chien WC. Risk of Colorectal Cancer in Patients With Attention-Deficit Hyperactivity Disorder: A Nationwide, Population-Based Cohort Study. Front Psychiatry 2021; 12:537137. [PMID: 33613335 PMCID: PMC7892783 DOI: 10.3389/fpsyt.2021.537137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The association between attention-deficit hypersensitivity disorder (ADHD) and the risk of developing colorectal cancer (CRC) is, as yet, to be investigated, and thus, we have conducted this nationwide, cohort study to examine the association in patients from Taiwan. Methods: In this study, 798 individuals with newly diagnosed ADHD and 2,394 (1:3) age-, gender-, and index year- matched controls without ADHD were enrolled, between 2000 and 2013, from the Longitudinal Health Insurance Database, a subset of the National Health Insurance Research Database in Taiwan. The cumulative incidence of CRC was assessed in each cohort by the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to estimate the crude, and the adjusted hazards ratios (HRs) with 95% confidence intervals (CIs), was conducted to estimate the association between ADHD and CRC. Results: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in patients with ADHD than in those without it (log rank test, p < 0.001). After adjustments for age, gender, comorbidities, and other covariates, the ADHD group was associated with an increased risk of CRC in comparison to the non-ADHD group (adjusted HR = 3.458, 95% CI = 1.640-7.293, p < 0.001). In addition, the usage of methylphenidate was not associated with the risk of developing CRC in patients with ADHD. Conclusion: This retrospective cohort study depicts the evidence that ADHD was associated with the increased risk of CRC. Further studies are needed to confirm the association and the underlying mechanisms.
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Affiliation(s)
- Je-Ming Hu
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Cheng Lee
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Artificial Intelligence Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzu-Chiao Lin
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Pi-Kai Chang
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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4
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Corona R, Dvorsky MR, Romo S, Parks AM, Bourchtein E, Smith ZR, Avila M, Langberg J. Integrating Tobacco Prevention Skills into an Evidence-Based Intervention for Adolescents with ADHD: Results from a Pilot Efficacy Randomized Controlled Trial. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1439-1453. [PMID: 32778992 PMCID: PMC7565255 DOI: 10.1007/s10802-020-00689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for tobacco use, but tobacco use prevention strategies are not regularly incorporated into evidence-based ADHD interventions. We conducted a pilot randomized-controlled trial to determine the feasibility of integrating tobacco use prevention skills into a behavioral treatment for ADHD and to provide preliminary efficacy data comparing a combined (ADHD + tobacco) intervention (N = 40) to an ADHD only intervention (N = 23) on tobacco risk outcomes. Sixty-three adolescents (72% male; 13-17 years) with ADHD and their caregivers were randomly assigned to condition and families were masked to condition. Parent and adolescent ratings were collected at baseline, immediate post-intervention, and at 3- and 9-month follow-up assessments. The combined intervention was (1) implemented with high fidelity (94%), (2) well received by parents and adolescents as evidenced by high levels of treatment attendance (82%) and satisfaction with the intervention, and (3) associated with parent- and adolescent-reported reductions in tobacco use risk. Relative to the ADHD intervention, the combined intervention buffered against increases in tobacco risk, including reduced intentions to smoke and maladaptive social normative beliefs, and increased parental control, family cohesion, and family communication about substance use. Effect sizes at post-treatment were in the small to moderate range. Overall, this study provides preliminary support for a parent-adolescent behavioral treatment supplemented with family-based tobacco prevention strategies. This approach targets families already in treatment for ADHD, reducing barriers that occur when families attend multi-session prevention programs in addition to ADHD treatment.
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Affiliation(s)
- Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA.
| | - Melissa R Dvorsky
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Stephanie Romo
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Amanda M Parks
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Elizaveta Bourchtein
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Zoe R Smith
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Melissa Avila
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
| | - Joshua Langberg
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, USA
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Hamidullah S, Thorpe HHA, Frie JA, Mccurdy RD, Khokhar JY. Adolescent Substance Use and the Brain: Behavioral, Cognitive and Neuroimaging Correlates. Front Hum Neurosci 2020; 14:298. [PMID: 32848673 PMCID: PMC7418456 DOI: 10.3389/fnhum.2020.00298] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Adolescence is an important ontogenetic period that is characterized by behaviors such as enhanced novelty-seeking, impulsivity, and reward preference, which can give rise to an increased risk for substance use. While substance use rates in adolescence are generally on a decline, the current rates combined with emerging trends, such as increases in e-cigarette use, remain a significant public health concern. In this review, we focus on the neurobiological divergences associated with adolescent substance use, derived from a cross-sectional, retrospective, and longitudinal studies, and highlight how the use of these substances during adolescence may relate to behavioral and neuroimaging-based outcomes. Identifying and understanding the associations between adolescent substance use and changes in cognition, mental health, and future substance use risk may assist our understanding of the consequences of drug exposure during this critical window.
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Affiliation(s)
| | - Hayley H A Thorpe
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Jude A Frie
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Richard D Mccurdy
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Jibran Y Khokhar
- Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
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Mitchell JT, Howard AL, Belendiuk KA, Kennedy TM, Stehli A, Swanson JM, Hechtman L, Arnold LE, Hoza B, Vitiello B, Lu B, Kollins SH, Molina BSG. Cigarette Smoking Progression Among Young Adults Diagnosed With ADHD in Childhood: A 16-year Longitudinal Study of Children With and Without ADHD. Nicotine Tob Res 2020. [PMID: 29538764 DOI: 10.1093/ntr/nty045] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for smoking cigarettes, but there is little longitudinal research on the array of smoking characteristics known to be prognostic of long-term smoking outcomes into adulthood. These variables were studied into early adulthood in a multisite sample diagnosed with ADHD combined type at ages 7-9.9 and followed prospectively alongside an age- and sex-matched local normative comparison group (LNCG). METHODS Cigarette smoking quantity, quit attempts, dependence, and other characteristics were assessed in the longitudinal Multimodal Treatment Study of Children with ADHD (MTA) eight times to a mean age of 24.9 years: ADHD n = 469; LNCG n = 240. RESULTS In adulthood, the ADHD group had higher rates of daily cigarette smoking, one or more quit attempts, shorter time to first cigarette of the day, and more severe withdrawal than the LNCG. The ADHD group did not appear to have better smoking cessation rates despite a higher proportion quitting at least once. Smoking quantity and nicotine dependence did not differ between groups. The ADHD group reported younger daily smoking onset and faster progression from smoking initiation to daily smoking across assessments. Finally, ADHD symptom severity in later adolescence and adulthood was associated with higher risk for daily smoking across assessments in the ADHD sample. CONCLUSIONS This study shows that ADHD-related smoking risk begins at a young age, progresses rapidly, and becomes resistant to cessation attempts by adulthood. Prevention efforts should acknowledge the speed of uptake; treatments should target the higher relapse risk in this vulnerable population. IMPLICATIONS Although childhood ADHD predicts later smoking, longitudinal studies of this population have yet to fully characterize smoking behaviors into adulthood that are known to be prognostic of long-term smoking outcome. The current study demonstrates earlier and faster progression to daily smoking among those with a childhood ADHD diagnosis, as well as greater risk for failed quit attempts. Prevention efforts should address speed of smoking uptake, while treatments are needed that address smoking relapse risk. The current study also demonstrates ADHD symptom severity over development increases daily smoking risk, implicating the need for continuous ADHD symptom management.
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Affiliation(s)
- John T Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | | | - Traci M Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - James M Swanson
- Department of Pediatrics, University of California, Irvine, CA
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH
| | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Benedetto Vitiello
- Division of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Bo Lu
- Division of Biostatistics, The Ohio State University, Columbus, OH
| | - Scott H Kollins
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Brooke S G Molina
- Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh, Pittsburgh, PA
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7
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Mitchell JT, McClernon FJ, Beckham JC, Brown RA, Lejuez CW, Kollins SH. Smoking abstinence effects on emotion dysregulation in adult cigarette smokers with and without attention-deficit/hyperactivity disorder. Drug Alcohol Depend 2019; 205:107594. [PMID: 31639512 PMCID: PMC6938720 DOI: 10.1016/j.drugalcdep.2019.107594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cigarette smoking is robustly associated with attention-deficit/hyperactivity disorder (ADHD), but little is known about psychological mechanisms accounting for this comorbid relationship. This study examined difficulties in emotion regulation, or emotion dysregulation, among adult cigarette smokers with and without ADHD. Emotion dysregulation was predicted to be higher in an ADHD group at screening and after 24 -h smoking abstinence compared to a non-ADHD group. METHODS Cigarette smokers with (n = 19) and without (n = 20) ADHD completed a screening visit, baseline visit, and two experimental visits: smoking as usual (i.e., smoking satiated) and after biochemically-verified 24 -h smoking abstinence (i.e., smoking abstinent). Three emotion dysregulation rating scales (two self-report and one clinician rated) were administered at the screening visit and experimental sessions. Experimental sessions also included two emotion dysregulation behavioral tasks. RESULTS The ADHD group scored higher on all three rating scales at screening (p's < .001). For experimental sessions, group (ADHD, non-ADHD) x condition (smoking satiated, smoking abstinence) interactions were not significant across measures. However, group main effects emerged indicating higher emotion dysregulation in the ADHD group across all measures (p's < .001). Main effects also emerged for experimental condition, but were more mixed across emotion dysregulation measures. CONCLUSIONS Emotion dysregulation was higher among adult smokers with ADHD and during smoking abstinence across diagnostic groups, suggesting that this malleable psychological mechanism plays a role in smoking both for those with and without ADHD-such findings can inform treatment and prevention efforts.
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Affiliation(s)
- John T. Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - F. Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jean C. Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Richard A. Brown
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Carl W. Lejuez
- College of Liberal Arts and Sciences, University of Kansas, Lawrence, KS, USA
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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8
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Luo SX, Covey LS, Hu MC, Winhusen TM, Nunes EV. Differential Posttreatment Outcomes of Methylphenidate for Smoking Cessation for Individuals With ADHD. Am J Addict 2019; 28:497-502. [PMID: 31538372 DOI: 10.1111/ajad.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/30/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In a multisite, randomized study (CTN-0029), a 3-month course of Osmotic-Release Oral System Methylphenidate (OROS-MPH) improved smoking cessation in a group of patients with higher baseline severity in Attention-Deficit/Hyperactivity Disorder (ADHD). This treatment, however, worsened smoking cessation outcome in the group with lower baseline ADHD severity. We want to examine whether this differential treatment effect persisted after OROS-MPH was discontinued. METHODS We conducted a secondary analysis of the 1-month follow-up data from CTN-0029 after the discontinuation of OROS-MPH (N = 134). Nicotine patch was tapered during this month. We tested whether OROS-MPH had an effect on self-reported 7-day abstinence by week, as well as possible treatment by baseline ADHD severity interactions. RESULTS Abstinence diminished overall in time after the end of the treatment. In the high baseline severity group, patients who received OROS-MPH had an advantage in 7-day abstinence at week 15 (40% for OROS-MPH vs 20% for placebo, odds ratio = 2.63, P = .028). In the lower severity group (n = 121), no difference was detected (29% for OROS-MPH vs 32% for placebo, P = 1.00) between the two treatment groups. There was also a significant treatment by baseline ADHD severity interaction (P = .03). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE OROS-MPH promotes abstinence beyond the course of treatment for patients with more severe ADHD, while the paradoxical effects in the lower baseline severity group is not persistent after medication discontinuation. Targeting ADHD in smoking cessation as a comorbidity therefore can have broader impact with more precise patient selection. (Am J Addict).
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Affiliation(s)
- Sean X Luo
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
| | - Lirio S Covey
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
| | - Theresa M Winhusen
- Division of Addiction Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Edward V Nunes
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
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Dvorsky MR, Langberg JM. Cigarette and e-cigarette use and social perceptions over the transition to college: The role of ADHD symptoms. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:318-330. [PMID: 30869922 PMCID: PMC6483890 DOI: 10.1037/adb0000450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cigarette and electronic cigarette (e-cigarette) use prevalence increases during adolescence and peaks in young adulthood, with substantial increases during the transition from high school to college especially more recently for e-cigarette use. It is important to identify the underlying factors that serve as risk factors for tobacco use and social perceptions about cigarette and e-cigarette use. It is unknown whether attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with social perceptions about tobacco or increased tobacco use during the high school to college transition. This three timepoint prospective longitudinal study evaluates the reciprocal relationship between ADHD symptoms and social perceptions about tobacco as well as the frequency of cigarette and e-cigarette use in a sample of 150 high school seniors (Mage = 18.25, 66.0% female, 65.3% White) across the transition to college. ADHD symptoms in high school predicted increases in e-cigarette use during the first semester of college, and this association maintained through the end of the first year. ADHD symptoms predicted changes in social perceptions about cigarette and e-cigarette use after the transition to college. ADHD symptoms were predicted by social perceptions about e-cigarettes at the beginning of college. Understanding the psychosocial mechanisms underlying the pathways from ADHD symptoms to e-cigarette use may advance tobacco use etiology and prevention efforts, which is important considering the rapid growth in e-cigarette use among emerging adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Berg CJ, Haardörfer R, Vu M, Getachew B, Lloyd SA, Lanier A, Childs D, Sandridge Y, Bierhoff J, Li J, Dossantos E, Windle M. Cigarette use trajectories in young adults: Analyses of predictors across system levels. Drug Alcohol Depend 2018; 188:281-287. [PMID: 29807215 PMCID: PMC6819815 DOI: 10.1016/j.drugalcdep.2018.03.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/23/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cigarette smoking escalates most in early to middle young adulthood. However, little research has examined a range of multilevel factors in relation to smoking trajectories during this time. METHODS We examined: 1) trajectories of cigarette smoking among 2967 US college students (aged 18-25) in a two-year, six-wave longitudinal study (using growth mixture modeling); and 2) intrapersonal- (i.e., other substance use, depressive symptoms, ADHD symptoms,); interpersonal- (i.e., adverse childhood events, social support, parental tobacco and marijuana use), and community-level (i.e., type of college, rural vs. urban setting) predictors of differing trajectories (using multinomial logistic regression). RESULTS We identified three trajectory classes: 1) Dabblers, who used cigarettes at one point in their life or not at all (85.6%); 2) College Onset Smokers, who began smoking regularly during the college years (6.2%); and 3) Later Onset Smokers, who began smoking during the mid- to late-20 s (8.2%). Multinomial regression (with Dabblers as the reference group) showed that predictors of being College Onset Smokers included being male (p = .031); Asian (p = .001) but not Black (p = .008; Ref: White); early onset smokers (i.e., initiation before age 15; p = .006); past 30-day users of little cigars/cigarillos (p = .024), alcohol (p < .001), and marijuana (p = .008); children of tobacco users (p = .050); and public (p = .031) or a technical college students (p < .001; Ref: private college); predictors of being Later Onset Smokers were being male (p = .019) and technical college students (p = .005). CONCLUSIONS Despite some young adults' smoking initiating/escalating in middle young adulthood, few risk factors were documented. This understudied period warrants greater examination to inform intervention.
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Affiliation(s)
- Carla J. Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA,Corresponding author at: Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322, USA. (C.J. Berg)
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Steven A. Lloyd
- Department of Psychological Science, University of North Georgia, 82 College Circle, Dahlonega, GA 30597, USA
| | - Angela Lanier
- Department of Kinesiology, Berry College, 2277 Martha Berry Hwy NW, Mount Berry, GA 30149, USA
| | - Donyale Childs
- Department of Nursing, 504 College Drive Albany, GA 31705, USA
| | - Yasmeni Sandridge
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Jennifer Bierhoff
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Jingjing Li
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Elliyah Dossantos
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
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Lee HJ, Tran DD, Morrell HER. Smoking, ADHD, and Problematic Video Game Use: A Structural Modeling Approach. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 21:281-286. [PMID: 29652524 DOI: 10.1089/cyber.2017.0429] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Problematic video game use (PVGU), or addiction-like use of video games, is associated with physical and mental health problems and problems in social and occupational functioning. Possible correlates of PVGU include frequency of play, cigarette smoking, and attention deficit hyperactivity disorder (ADHD). The aim of the current study was to explore simultaneously the relationships among these variables as well as test whether two separate measures of PVGU measure the same construct, using a structural modeling approach. Secondary data analysis was conducted on 2,801 video game users (Mage = 22.43 years, standard deviation [SD]age = 4.7; 93 percent male) who completed an online survey. The full model fit the data well: χ2 (2) = 2.017, p > 0.05; root mean square error of approximation (RMSEA) = 0.002 (90% CI [0.000-0.038]); comparative fit index (CFI) = 1.000; standardized root mean square residual (SRMR) = 0.004; and all standardized residuals <|0.1|. All freely estimated paths were statistically significant. ADHD symptomatology, smoking behavior, and hours of video game use explained 41.8 percent of variance in PVGU. Tracking these variables may be useful for PVGU prevention and assessment. Young's Internet Addiction Scale, adapted for video game use, and the Problem Videogame Playing Scale both loaded strongly onto a PVGU factor, suggesting that they measure the same construct, that studies using either measure may be compared to each other, and that both measures may be used as a screener of PVGU.
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Affiliation(s)
- Hyo Jin Lee
- Department of Psychology, Loma Linda University , Loma Linda, California
| | - Denise D Tran
- Department of Psychology, Loma Linda University , Loma Linda, California
| | - Holly E R Morrell
- Department of Psychology, Loma Linda University , Loma Linda, California
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12
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Jones HA, Eddy LD, Rabinovitch AE, Snipes DJ, Wilson SA, Parks AM, Karjane NW, Svikis DS. Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women. J Clin Psychol 2017; 74:665-679. [DOI: 10.1002/jclp.22538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
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13
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Watterson E, Spitzer A, Watterson LR, Brackney RJ, Zavala AR, Olive MF, Sanabria F. Nicotine-induced behavioral sensitization in an adult rat model of attention deficit/hyperactivity disorder (ADHD). Behav Brain Res 2016; 312:333-40. [PMID: 27363925 DOI: 10.1016/j.bbr.2016.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/23/2016] [Accepted: 06/26/2016] [Indexed: 12/23/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is associated with increased risk of tobacco dependence. Nicotine, the main psychoactive component of tobacco, appears to be implicated in ADHD-related tobacco dependence. However, the behavioral responsiveness to nicotine of the prevalent animal model of ADHD, the spontaneously hypertensive rat (SHR), is currently underinvestigated. The present study examined the activational effects of acute and chronic nicotine on the behavior of adult male SHRs, relative to Wistar Kyoto (WKY) controls. Experiment 1 verified baseline strain differences in open-field locomotor activity. Experiment 2 tested for baseline strain differences in rotational behavior using a Rotorat apparatus. Adult SHR and WKY rats were then exposed to a 7-day regimen of 0.6mg/kg/d s.c. nicotine, or saline, prior to each assessment. A separate group of SHRs underwent similar training, but was pre-treated with mecamylamine, a cholinergic antagonist. Nicotine sensitization, context conditioning, and mecamylamine effects were then tested. Baseline strain differences were observed in open-field performance and in the number of full rotations in the Rotorat apparatus, but not in the number of 90° rotations or direction changes. In these latter measures, SHRs displayed weaker nicotine-induced rotational suppression than WKYs. Both strains expressed nicotine-induced sensitization of rotational activity, but evidence for strain differences in sensitization was ambiguous; context conditioning was not observed. Mecamylamine reversed the effects of nicotine on SHR performance. These findings are consistent with the hypothesis that a reduced aversion to nicotine (expressed in rats as robust locomotion) may facilitate smoking among adults with ADHD.
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Affiliation(s)
- Elizabeth Watterson
- Arizona State University, Department of Psychology, P.O. Box 871104, Tempe, AZ 85287, United States
| | - Alexander Spitzer
- Arizona State University, Department of Psychology, P.O. Box 871104, Tempe, AZ 85287, United States
| | - Lucas R Watterson
- Arizona State University, Department of Psychology, P.O. Box 871104, Tempe, AZ 85287, United States; Center for Substance Abuse Research Temple University School of Medicine, 3500N. Broad St., Medical Education and Research Bldg., 8th Floor, Philadelphia, PA 19140, United States
| | - Ryan J Brackney
- Arizona State University, Department of Psychology, P.O. Box 871104, Tempe, AZ 85287, United States
| | - Arturo R Zavala
- California State University, Long Beach, CA 90840, United States
| | - M Foster Olive
- Arizona State University, Department of Psychology, P.O. Box 871104, Tempe, AZ 85287, United States
| | - Federico Sanabria
- Arizona State University, Department of Psychology, P.O. Box 871104, Tempe, AZ 85287, United States.
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Murphy KG, Flory K. Motives underlying smoking in college students with ADHD. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:350-359. [DOI: 10.1080/00952990.2016.1203434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kerrie Glass Murphy
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kate Flory
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
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15
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Liebrenz M, Fisher CE, Nellen R, Frei A, Biechl AC, Hiestand N, Huber A, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder and nicotine withdrawal: a qualitative study of patient perceptions. BMC Psychiatry 2016; 16:208. [PMID: 27377376 PMCID: PMC4932755 DOI: 10.1186/s12888-016-0911-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/07/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Nicotine use has been reported to ameliorate symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Furthermore, adults with ADHD have a relatively high prevalence of cigarette smoking and greater difficulty abstaining from smoking. Overall, though, there is scant literature investigating the beliefs, perceptions and experiences of smokers with ADHD regarding smoking cessation and withdrawal. METHODS Our participants (n = 20) fulfilling criteria for ADHD and a past or current dependence from nicotine were recruited from the in- and outpatient clinic of the Zurich University Psychiatric Hospital and the Psychiatric Services Aargau (Switzerland). We conducted in-depth interviews to explore their motivations to quit, past experiences with and expectations about quitting using a purposeful sampling plan. The sample was selected to provide diversity in relation to level of nicotine dependence, participation in a smoking-cessation program, gender, age, martial status and social class. Mayring's qualitative content analysis approach was used to evaluate findings. RESULTS Adult smokers with ADHD had made several attempts to quit, experienced intense withdrawal symptoms, and relapsed early and often. They also often perceived a worsening of ADHD symptoms with nicotine abstinence. We identified three motives to quit smoking: 1) health concerns, 2) the feeling of being addicted, and 3) social factors. Most participants favored a smoking cessation program specifically designed for individuals with ADHD because they thought ADHD complicated their nicotine withdrawal and that an ADHD-specific smoking cessation program should address specific symptoms of this disorder. CONCLUSIONS Since treatment initiation and adherence associate closely with perception, we hope these findings will result in better cessation interventions for the vulnerable subgroup of smokers with ADHD.
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Affiliation(s)
- Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 16-18, Bern, 3012, Switzerland.
| | - Carl Erik Fisher
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032 USA
| | - Romilda Nellen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Anja Frei
- Institute for General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Anne-Catherine Biechl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nina Hiestand
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Alice Huber
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Dominique Eich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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De Alwis D, Tandon M, Tillman R, Luby J. Nonverbal Reasoning in Preschool Children: Investigating the Putative Risk of Secondhand Smoke Exposure and Attention-Deficit/Hyperactivity Disorder as a Mediator. Scand J Child Adolesc Psychiatr Psychol 2016; 3:115-125. [PMID: 26726310 PMCID: PMC4696599 DOI: 10.21307/sjcapp-2015-012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Exposure to secondhand smoke (SHS) has been found to be associated with cognitive deficits in children. However, relatively little is known about the relationship between SHS exposure, cognitive deficits, and smoking-related psychopathology, specifically attention-deficit/hyperactivity disorder (ADHD) and externalizing disorders such as conduct disorder (CD) and oppositional defiant disorder (ODD) in preschool children. METHODS Children (n = 54) between the ages of 4 and 6 years from a comprehensive, longitudinal study of preschool emotional development were included in this study. Each child's primary caregiver completed questionnaires and interviews related to childhood psychopathology. SHS exposure was estimated with the use of saliva cotinine values. RESULTS After adjustment for sociodemographic factors (e.g., age, gender, an income-to-needs ratio) and for ADHD, CD, and ODD symptoms, exposure to SHS was found to be negatively associated with preschool children's nonverbal reasoning skills. Exposure to SHS continued to be negatively associated with nonverbal reasoning skills after adjustment for maternal education, maternal smoking during pregnancy, and maternal reports of exposure to SHS during pregnancy in separate models. CONCLUSIONS Children who grow up in an environment with adults who smoke are vulnerable to several social and environmental risk factors. The findings of this study suggest that exposure to SHS during early childhood should also be considered as a potential variable in the risk trajectory and as a marker of other associated risks when formulating public health intervention and prevention strategies.
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Affiliation(s)
- Duneesha De Alwis
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Mini Tandon
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
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17
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Kulkarni M, Huddlestone L, Taylor A, Sayal K, Ratschen E. A cross-sectional survey of mental health clinicians' knowledge, attitudes, and practice relating to tobacco dependence among young people with mental disorders. BMC Health Serv Res 2014; 14:618. [PMID: 25424565 PMCID: PMC4251854 DOI: 10.1186/s12913-014-0618-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/19/2014] [Indexed: 11/26/2022] Open
Abstract
Background Mental health services in England are smoke-free by law and expected to provide comprehensive support to patients who smoke. Although clinicians’ knowledge in this area is reported to be limited, research exploring the issue in Child and Adolescent Mental Health Services (CAMHS) is lacking. This study aimed to investigate the knowledge, attitudes, and practice of clinicians working within specialist and highly specialist Child and Adolescent Mental Health Services (CAMHS) relating to tobacco dependence, its treatment and its relation to mental disorder. Methods A cross-sectional survey of clinicians working across all CAMHS teams of a large UK National Health Service mental health Trust. Results Sixty clinicians (50% response rate) completed the survey. Less than half (48.3%) believed that addressing smoking was part of their responsibility, and half (50%) asserted confidence in supporting patients in a cessation attempt. Misconceptions relating to smoking were present across all staff groups: e.g. only 40% of respondents were aware of potential interactions between smoking and antipsychotic medications, although psychiatrists were more knowledgeable than non-medical clinicians (91.6% vs 27.1%; OR 3.4, p < .001). Self-reported attendance at smoking-related training was significantly associated with more proactive clinical practice. Conclusions There is a need to improve clinicians’ knowledge, capacity and confidence in effectively identifying, motivating, supporting and treating young smokers in the context of treatment for mental disorders. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0618-x) contains supplementary material, which is available to authorized users.
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18
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De Alwis D, Agrawal A, Reiersen AM, Constantino JN, Henders A, Martin NG, Lynskey MT. ADHD symptoms, autistic traits, and substance use and misuse in adult Australian twins. J Stud Alcohol Drugs 2014; 75:211-21. [PMID: 24650814 DOI: 10.15288/jsad.2014.75.211] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder frequently co-occur. Several studies show increased risk of substance use disorders in ADHD, yet there is limited information related to how ADHD symptoms, autistic traits, and their combined effects are associated with nicotine, alcohol, and cannabis use and use disorders in the general population. METHOD Cross-sectional interview and self-report questionnaire data from 3,080 young adult Australian twins (mean age 31.9 years) were used to assess ADHD symptoms, autistic traits, substance use, and substance use disorders. Substance use disorders-based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria-were assessed in the full sample as well as in those who reported substance use. Logistic regression analyses were used for comparing the associations between ADHD symptoms, autistic traits, substance use, and substance misuse after conduct disorder, sex, age, and zygosity were controlled for. RESULTS Greater ADHD symptoms and autistic traits scores were associated with elevated levels of regular smoking; cannabis use; and nicotine, alcohol, and cannabis use disorders, even after conduct disorder was adjusted for. In contrast, for alcohol use, those with high autistic traits scores were less likely to report drinking to intoxication. However, upon initiation, and similar to the findings for nicotine and cannabis, they were at elevated risk for developing alcohol dependence. CONCLUSIONS Increased liability to ADHD and elevated autistic traits scores were associated with substance use and misuse, with the exception of alcohol use. Given the social underpinnings of drinking, persons with autistic traits may be less likely to engage in it; however, upon engagement in drinking, their vulnerability to alcohol dependence is elevated.
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Affiliation(s)
- Duneesha De Alwis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Angela M Reiersen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - John N Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Anjali Henders
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Nicholas G Martin
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
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Kirst M, Mecredy G, Borland T, Chaiton M. Predictors of substance use among young adults transitioning away from high school: a narrative review. Subst Use Misuse 2014; 49:1795-807. [PMID: 25033376 DOI: 10.3109/10826084.2014.933240] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Young adulthood has been shown to be a time of increased substance use. Yet, not enough is known about which factors contribute to initiation and progression of substance use among young adults specifically during the transition year away from high school. OBJECTIVES A narrative review was undertaken to increase understanding of the predictors of changes in use of tobacco, alcohol, cannabis, other illicit drugs, and mental health problems among young adults during the transition period after high school. METHODS A review of academic literature examining predictors of the use of tobacco, alcohol and cannabis, and co-morbidities (e.g., co-occurring substance use and/or mental health issues) among young adults transitioning from high school to post-secondary education or the workforce. RESULTS Twenty six studies were included in the review. The majority of the studies (19) examined substance use during the transition from high school to post-secondary settings. Seven studies examined substance use in post-secondary settings. The studies consistently found that substance use increases among young adults as they transition away from high school. During the transition away from high school, common predictors of substance use include substance use in high school, and peer influence. Common predictors of substance use in post-secondary education include previous substance use, peer influence, psychological factors and mental health issues. Conclusions/Importance: Further research on social contextual influences on substance use, mental health issues, gender differences and availability of substances during the transition period is needed to inform the development of new preventive interventions for this age group.
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Affiliation(s)
- Maritt Kirst
- 1Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
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20
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Smoking, alcohol consumption, and drug use among adolescents with psychiatric disorders compared with a population based sample. J Adolesc 2014; 37:1189-99. [PMID: 25190498 DOI: 10.1016/j.adolescence.2014.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/28/2014] [Accepted: 08/07/2014] [Indexed: 12/12/2022]
Abstract
This study investigated frequencies of smoking, alcohol use, and illicit drug use by diagnostic category in 566 adolescent psychiatric patients, comparing this sample with 8173 adolescents from the general population in Norway who completed the Young-HUNT 3 survey. Frequencies of current alcohol use were high in both samples but were lower among psychiatric patients. Compared with adolescents in the general population, adolescents in the clinical sample had a higher prevalence of current smoking and over four times higher odds of having tried illicit drugs. In the clinical sample, those with mood disorders reported the highest frequencies of smoking, alcohol use, and illicit drug use, whereas those with autism spectrum disorders reported the lowest frequencies. Our results show an increased prevalence of risky health behaviors among adolescents with psychiatric disorders compared with the general population. The awareness of disorder-specific patterns of smoking and substance use may guide preventive measures.
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Mitchell JT, Dennis MF, English JS, Dennis PA, Brightwood A, Beckham JC, Kollins SH. Ecological momentary assessment of antecedents and consequences of smoking in adults with attention-deficit/hyperactivity disorder. Subst Use Misuse 2014; 49:1446-56. [PMID: 24827866 PMCID: PMC4116432 DOI: 10.3109/10826084.2014.912229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The current study assessed antecedents and consequences of ad lib cigarette smoking in smokers diagnosed with attention-deficit/hyperactivity disorder (ADHD) using ecological momentary assessment (EMA). Adult smokers with ADHD (n = 17) completed 870 smoking and 622 nonsmoking electronic diary entries over a 7-day observation period of their naturalistic smoking behavior. Data collection occurred from 2011 to 2012. Generalized estimating equations indicated that ADHD smokers were more likely to smoke when urge to smoke, negative affect, boredom, stress, worry, and restlessness were elevated. In addition, participants were more likely to smoke in situations that elicited higher levels of nervousness and frustration. ADHD symptoms, in general, did not differ between smoking and nonsmoking contexts, though hyperactive-impulsive ADHD symptoms were elevated prior to smoking in frustrating situations. Additional situational antecedent variables were associated with smoking, including being in the presence of others smoking, being in a bar or restaurant, while outside, and while consuming caffeinated or alcoholic beverages. Participants also reported a significant improvement in urge to smoke, negative affect, stress, hunger, and ADHD symptoms after smoking a cigarette. Findings suggest certain contextual factors that may maintain ad lib cigarette smoking in smokers with ADHD and identify potential treatment targets in smoking cessation interventions for this at-risk group. Clinical implications and future research directions are discussed. Funding for this study was provided by the National Institute on Drug Abuse.
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Affiliation(s)
- John T Mitchell
- 1Duke University Medical Center, Durham, North Carolina, USA
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Schoenfelder EN, Faraone SV, Kollins SH. Stimulant treatment of ADHD and cigarette smoking: a meta-analysis. Pediatrics 2014; 133:1070-80. [PMID: 24819571 PMCID: PMC4531271 DOI: 10.1542/peds.2014-0179] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) have a significantly higher risk of cigarette smoking. The nature of the relationship between smoking and psychostimulant medications commonly used to treat ADHD is controversial. Our objective was to examine the relationship between stimulant treatment of ADHD and cigarette smoking by using meta-analysis, and to identify study and sample characteristics that moderate this relationship. METHODS Literature searches on PubMed and PsycInfo databases identified published studies for inclusion. Included studies compared cigarette smoking outcomes for stimulant-treated and untreated ADHD individuals. Seventeen studies met inclusion criteria, and 14 (total n = 2360) contained sufficient statistical information for inclusion in the meta-analysis. Two authors extracted odds ratios or frequencies of smokers in the treatment or nontreatment groups, and coded study characteristics including sample source, percentage of male participants, follow-up length, treatment consistency, type of smoking measure, prospective study, and controlling for comorbidities. RESULTS Meta-analysis revealed a significant association between stimulant treatment and lower smoking rates. Meta-regression indicated that effect sizes were larger for studies that used clinical samples, included more women, measured smoking in adolescence rather than adulthood, conceptualized stimulant treatment as consistent over time, and accounted for comorbid conduct disorder. CONCLUSIONS Nearly all studies were naturalistic, precluding causal inferences. Available data were insufficient to examine additional influences of patient demographics, treatment effectiveness, or other comorbidities. Consistent stimulant treatment of ADHD may reduce smoking risk; the effect was larger in samples with more severe psychopathology. Implications for further research, treatment of ADHD, and smoking prevention are discussed.
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Affiliation(s)
- Erin N. Schoenfelder
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina; and
| | - Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina; and
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Kollins SH, English JS, Itchon-Ramos N, Chrisman AK, Dew R, O’Brien B, McClernon FJ. A pilot study of lis-dexamfetamine dimesylate (LDX/SPD489) to facilitate smoking cessation in nicotine-dependent adults with ADHD. J Atten Disord 2014; 18:158-68. [PMID: 22508760 PMCID: PMC3421044 DOI: 10.1177/1087054712440320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The goal of this study was to assess the efficacy and tolerability of lis-dexamfetamine dimesylate (LDX) as an adjunct to nicotine replacement therapy in adult smokers with ADHD who were undergoing a quit attempt. METHODS Thirty-two regular adult smokers with ADHD were randomized to receive LDX (n = 17) or placebo (n = 15) in addition to nicotine patch concurrent with a quit attempt. RESULTS There were no differences between smokers assigned to LDX versus placebo in any smoking outcomes. Participants treated with LDX demonstrated significant reductions in self-reported and clinician-rated ADHD symptoms. LDX was well tolerated in smokers attempting to quit. DISCUSSION In general, LDX does not facilitate smoking cessation in adults with ADHD more than does placebo, though both groups significantly reduced smoking. LDX demonstrated efficacy for reducing ADHD symptoms in adult smokers engaging in a quit attempt.
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Affiliation(s)
- Scott H. Kollins
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Joseph S. English
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Nilda Itchon-Ramos
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Allan K. Chrisman
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Rachel Dew
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Benjamin O’Brien
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - F. Joseph McClernon
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
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Mulligan RC, Reiersen AM, Todorov AA. Attention-Deficit/Hyperactivity Disorder, Autistic Traits, and Substance Use Among Missouri Adolescents. Scand J Child Adolesc Psychiatr Psychol 2014; 2:86-92. [DOI: 10.21307/sjcapp-2014-012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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ADHD diagnosis may influence the association between polymorphisms in nicotinic acetylcholine receptor genes and tobacco smoking. Neuromolecular Med 2013; 16:389-97. [PMID: 24375168 DOI: 10.1007/s12017-013-8286-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
Polymorphisms in the CHRNA5-CHRNA3-CHRNB4 gene cluster have been shown to be involved in tobacco smoking susceptibility. Considering that attention deficit/hyperactivity disorder (ADHD) not only increases the risk but may also influence the molecular mechanisms of tobacco smoking, we analyzed the association between polymorphisms in the nicotinic acetylcholine receptor genes and tobacco smoking among individuals with or without ADHD. The sample included 1,118 subjects divided into four groups according to smoking status and ADHD diagnosis. Our results demonstrate that the minor alleles of two polymorphisms (rs578776 and rs3743078) in the CHRNA3 gene are associated with an increased risk of tobacco smoking only among patients with ADHD. These alleles have been shown in previous studies to be protective factors for smoking in subjects without ADHD. These findings add to existing evidence that ADHD may exert an important modifying effect on the genetic risk of smoking and should be considered in tobacco smoking association studies.
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Kollins SH, Schoenfelder E, English JS, McClernon FJ, Dew RE, Lane SD. Methylphenidate does not influence smoking-reinforced responding or attentional performance in adult smokers with and without attention deficit hyperactivity disorder (ADHD). Exp Clin Psychopharmacol 2013; 21:375-84. [PMID: 24099358 PMCID: PMC4145471 DOI: 10.1037/a0033851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with Attention Deficit Hyperactivity Disorder (ADHD) smoke cigarettes at rates higher than the general population and questions have been raised about how stimulant drugs-the frontline pharmacological treatment for ADHD-influence smoking risk and behavior in those with ADHD. In the present study adult regular smokers with (n = 16) and without (n = 17) ADHD participated in 3 experimental sessions in which they completed a Progressive Ratio (PR) task to measure the relative reinforcing effects of cigarette smoking and money after oral administration of placebo and 2 active doses of methylphenidate (10 mg and 40 mg). We also measured attention and inhibitory control via a Continuous Performance Test (CPT). Methylphenidate had no effect on smoking-reinforced responding, attention, or inhibitory control in either group. Attention and inhibitory control were associated with smoking-reinforced responding, but unsystematically and only in the non-ADHD group. Several design features, such as the value of the monetary response option, the PR schedule, and the potential effects of smoking on attention and inhibitory control, could have contributed to the negative findings and are discussed as such. Although inconsistent with some previous human laboratory studies of stimulant drugs and smoking, results are consistent with recent trials of stimulant drugs as adjuncts for smoking cessation in adult smokers with ADHD. In general, methylphenidate at mild and moderate doses did not influence the relative reinforcing effects of cigarette smoking in adults with and without ADHD.
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Affiliation(s)
- Scott H. Kollins
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - Erin Schoenfelder
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - Joseph S. English
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - F. Joseph McClernon
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham VAMC, 116B, 508 Fulton Street, Durham, NC 27705
| | - Rachel E. Dew
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - Scott D. Lane
- Department of Psychiatry, University of Texas Health Science Center – Houston, Center for Neurobehavioral Research on Addictions, 1941 East Road, Houston, TX 77054
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Mitchell JT, McIntyre EM, McClernon FJ, Kollins SH. Smoking motivation in adults with attention-deficit/hyperactivity disorder using the Wisconsin inventory of smoking dependence motives. Nicotine Tob Res 2013; 16:120-5. [PMID: 24078759 DOI: 10.1093/ntr/ntt144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokers with attention-deficit/hyperactivity disorder (ADHD) differ from smokers without ADHD across a range of smoking outcomes (e.g., higher prevalence rates of smoking, faster progression to regular smoking, and greater difficulty quitting). Moreover, ADHD as a disorder has been characterized by deficits in fundamental motivational processes. To date, few studies have examined how motivation for smoking might differ between nicotine-dependent individuals with and without ADHD. The goal of this study was to assess whether specific smoking motivation factors differentiate smokers with and without ADHD as measured by an empirically derived self-report measure of smoking motivations. METHODS Smokers with (n = 61) and without (n = 89) ADHD participated in a range of laboratory and clinical studies that included the Wisconsin Inventory of Smoking Dependence Motives (WISDM). RESULTS A series of one-way analysis of covariances statistically controlling for age and race indicated that smokers with ADHD scored higher on the following WISDM subscales than their non-ADHD peers: automaticity, loss of control, cognitive enhancement, cue exposure, and negative reinforcement. Smokers in the non-ADHD group yielded higher scores on the social- environmental goads WISDM subscale. No group by gender interactions emerged. CONCLUSIONS Cigarette smokers with ADHD report different motives for smoking than smokers without ADHD. Clarifying the role of these motivational factors has implications for smoking prevention and treatment.
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Affiliation(s)
- John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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Hammerness P, Joshi G, Doyle R, Georgiopoulos A, Geller D, Spencer T, Petty CR, Faraone SV, Biederman J. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. J Pediatr 2013; 162:22-7.e2. [PMID: 22878114 DOI: 10.1016/j.jpeds.2012.06.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/07/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although attention-deficit hyperactivity disorder (ADHD) is a well-known risk factor for cigarette smoking, prospective studies aimed at reducing smoking risk in this population are critically needed. STUDY DESIGN This was a 2-year, prospective, open-label clinical trial of extended-release methylphenidate for smoking prevention in adolescents with ADHD (n = 154). Smoking outcomes were assessed with the Fagerstrom Tolerance Questionnaire. Comparisons were made using data from a historical, naturalistic sample of ADHD (n = 103) and non-ADHD comparators (n = 188) of similar age and sex assessed with the same assessment battery as that used in subjects participating in the clinical trial. RESULTS The smoking rate at endpoint (mean, 10 months of methylphenidate treatment) was low in the clinical trial subjects and not significantly different from that in the non-ADHD comparators or the ADHD comparators receiving stimulants naturalistically (7.1% vs 8.0% vs 10.9%; P > .20). In contrast, the smoking rate was significantly lower in the clinical trial subjects than in the naturalistic sample of ADHD comparators who were not receiving stimulant treatment (7.1% vs 19.6%; P = .009 [not significant], adjusting for comorbid conduct disorder and alcohol and drug abuse). CONCLUSION Although considered preliminary until replicated in future randomized clinical trials, the findings from this single-site, open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking in adolescents with ADHD. If confirmed, this finding would have significant clinical and public health impacts.
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Affiliation(s)
- Paul Hammerness
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02138, USA.
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Wilkinson AV, Gabriel KP, Wang J, Bondy ML, Dong Q, Wu X, Shete S, Spitz MR. Sensation-seeking genes and physical activity in youth. GENES BRAIN AND BEHAVIOR 2012. [PMID: 23190435 DOI: 10.1111/gbb.12006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many studies examining genetic influences on physical activity (PA) have evaluated the impact of single nucleotide polymorphisms (SNPs) related to the development of lifestyle-related chronic diseases, under the hypothesis that they would be associated with PA. However, PA is a multidetermined behavior and associated with a multitude of health consequences. Thus, examining a broader range of candidate genes associated with a broader range of PA correlates may provide new insights into the genetic underpinnings of PA. In this study, we focus on one such correlate - sensation-seeking behavior. Participants (N = 1130 Mexican origin youth) provided a saliva sample and data on PA and sensation-seeking tendencies in 2008-2009. Participants were genotyped for 630 functional and tagging variants in the dopamine, serotonin and cannabinoid pathways. Overall 30% of participants (males - 37.6% and females - 22.0%) reported ≥60 min of PA on 5 of 7 days. After adjusting for gender, age and population stratification, and applying the Bayesian False Discovery Probability approach for assessing noteworthiness, four gene variants were significantly associated with PA. In a multivariable model, being male, having higher sensation-seeking tendencies and at least one copy of the minor allele for SNPs in angiotensin I-converting enzyme gene [ACE; rs8066276 odds ratio (OR) = 1.44; P = 0.012] and tryptophan hydroxylase 2 gene (TPH2; rs11615016 OR = 1.73; P = 0.021) were associated with increased likelihood of meeting PA recommendations. Participants with at least one copy of the minor allele for SNPs in synaptosomal-associated protein 25 gene (SNAP25; rs363035 OR = 0.53; P = 0.005) and cannabinoid receptor 1 gene (CNR1; rs6454672 OR = 0.62; P = 0.022) have decreased likelihood of meeting PA recommendations. Our findings extend current knowledge of the complex relationship between PA and possible genetic underpinnings.
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Affiliation(s)
- A V Wilkinson
- Division of Epidemiology, Human Genetics and Environmental Science, University of Texas School of Public Health, Austin Regional Campus, Austin, TX 78701, USA.
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Massey SH, Compton MT. Psychological differences between smokers who spontaneously quit during pregnancy and those who do not: a review of observational studies and directions for future research. Nicotine Tob Res 2012; 15:307-19. [PMID: 22949579 DOI: 10.1093/ntr/nts142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although remarkable interindividual differences among pregnant smokers' decision/ability to quit have been documented, the psychological factors that may account for these differences have received less attention and comprised the primary aim of this review. METHODS We searched the medical and behavioral sciences literature from 1996 to November 2011 using PubMed and PsycINFO(®). Fifty-one articles were identified based on titles or abstracts. These articles were reviewed in full and searched for quantitative observational studies of population-based or clinical samples, with the main topic of comparing smokers who quit spontaneously during pregnancy with those who did not, utilizing multivariable analyses. RESULTS The eight pertinent studies reviewed herein included four longitudinal studies and four cross-sectional analyses. Amidst significant variability among measures used, social support, depressive symptoms, and anxiety appeared unrelated to smoking cessation during pregnancy. Furthermore, when severity of nicotine dependence was controlled, maternal history of attention-deficit/hyperactivity disorder, depression, bipolar disorder, and schizophrenia all showed no independent relationship with smoking cessation during pregnancy, whereas maternal history of conduct disorder did. Secure attachment, prosocial personality, self-esteem, and perceived parenting competence were additional predictors of cessation during pregnancy. CONCLUSIONS A greater understanding of psychological factors that differentiate smokers who spontaneously quit during pregnancy from those who do not is crucial to the design of more effective prenatal smoking cessation interventions and also may elucidate causal mechanisms that underlie the well-established link between maternal smoking during pregnancy and offspring behavioral problems. Directions for future research and public health and policy implications are discussed.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences Washington, DC 20037, USA.
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Biederman J, Petty CR, Hammerness P, Batchelder H, Faraone SV. Cigarette smoking as a risk factor for other substance misuse: 10-year study of individuals with and without attention-deficit hyperactivity disorder. Br J Psychiatry 2012; 201:207-14. [PMID: 22844023 DOI: 10.1192/bjp.bp.111.100339] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We previously documented that cigarette smoking is a risk factor for subsequent alcohol and drug misuse and dependence in adolescent girls with attention-deficit hyperactivity disorder (ADHD). AIMS To revisit this hypothesis with a large longitudinal sample of both genders followed up for 10 years into young adulthood. METHOD We used data from two identically designed, longitudinal, case-control family studies of boys and girls with and without ADHD ascertained from psychiatric and paediatric sources. We studied 165 individuals with ADHD and 374 controls followed up longitudinally and masked for 10 years. We assessed ADHD, smoking and substance use status using structured diagnostic interviews. We tested the association between cigarette smoking and subsequent substance use outcomes using Cox proportional hazard regression models. RESULTS Youth with ADHD who smoked cigarettes (n = 27) were significantly more likely to subsequently develop drug misuse and dependence compared with youth with ADHD who did not smoke (n = 138, P<0.05). CONCLUSIONS These results confirm that cigarette smoking increases the risk for subsequent drug and alcohol use disorders among individuals with ADHD. These findings have important public health implications, and underscore the already pressing need to prevent smoking in children with ADHD.
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Affiliation(s)
- Joseph Biederman
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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