Attention Deficit Hyperactivity Disorder symptoms and smoking trajectories: Race and gender differences
Introduction
Individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) smoke more cigarettes than those without ADHD (Gudjonsson et al., 2012). ADHD symptoms below the threshold for clinical diagnosis, also, adversely influence smoking outcomes (Chang et al., 2012; Kollins et al., 2005, Tercyak et al., 2002). The relative contributions of the different ADHD symptom domains (Hyperactive-Impulsive [HI] vs. Inattention [IN]) have been of interest in several studies (Fuemmeler et al., 2007, Kollins et al., 2005, McClernon et al., 2008, Polanczyk et al., 2010, Ranby et al., 2012, Van Voorhees et al., 2012, Willoughby et al., 2009). Some studies have shown IN symptoms are more predictive of smoking outcomes (e.g., Tercyak et al., 2002, Aytaclar et al., 1999, Burke et al., 2001, Molina and Pelham, 2003) than HI; whereas others report HI symptoms are the stronger predictor (e.g., Kollins et al., 2005). Drawing comparisons across studies is difficult given the differences in methods used to assess ADHD symptoms, age of participants, and the smoking behavior. Continued work is needed to better understand the relative role of HI and IN symptoms on smoking behavior over the course of development.
Race and gender are highly relevant to smoking behavior. Previous studies show that Whites are more likely to become regular or heavy smokers than Blacks (White et al., 2004), whereas Blacks are more likely to continue smoking into adulthood (Kandel et al., 2011). While most studies of smoking focus on Whites and Blacks, Chen and Jacobson (2012) examined the developmental pattern of cigarette smoking among Hispanic, White, and Black adolescents. They documented that Hispanic youth experienced higher rates of smoking during early adolescence compared to White and Black youth, White youth reported increased cigarette use during adolescence, and Black youth showed higher levels of smoking than White youth after entering adulthood. With regard to gender, males smoke significantly more than females during adolescence and adulthood though some exceptions have been noted (Kivinieme et al., 2011, Substance Abuse and Mental Health Services Administration, 2012). For example, Chen and Jacobson (2012) showed that females smoked more than males in early adolescence, but males smoked more than females from middle adolescence to adulthood, suggesting that the relation between gender and smoking varies across development. Despite documented differences in smoking behavior by race and gender, little is known about whether gender and race modify the association between ADHD and smoking outcomes.
Utilizing Add Health data, this study extended previous work that only either (a) looked at the relationships between ADHD symptoms and smoking outcomes with gender and ethnicity being controlled (e.g., Fuemmeler et al., 2007), or (b) focused primary on the impact of gender and ethnicity on smoking trajectories (e.g., Chen and Jacobson, 2012). The current study differs from previous studies by investigating the unique contribution of HI and IN symptoms on smoking trajectories from early adolescence to adulthood as a function of race and gender. A clearer understanding of how race and gender influence the relationship between ADHD symptoms and smoking over development has the potential to elucidate the etiology of smoking, and inform treatment and prevention approaches. This study (a) examined the overall severity and directionality (HI vs. IN) of ADHD symptoms in predicting smoking from ages 13 to 32, and (b) assessed whether race and gender differentially influenced the association between ADHD symptoms and smoking.
Section snippets
Participants
Data were drawn from 14,779 Add Health participants (53.2% female) interviewed from Waves I to IV. Respondents completed in-home surveys during the 1994–1995 school year (Wave I) and three additional times: Wave II during 1996, Wave III during 2001–2002, and Wave IV during 2008–2009. The participants’ mean ages for each of the four waves were 15.65 (SD = 1.75), 16.22 (SD = 1.64), 22.96 (SD = 1.77), and 28.9 (SD = 1.76), respectively. Study design and data collection have been described elsewhere (see
Sample characteristics
Around half of the participants were female (54.5%). The racial groups included Whites (60.9%), Blacks (22.5%), and Hispanics (16.5%). Approximately 24% of the participants’ primary caregivers had earned college degrees. The percentage of participants reporting six or more HI symptoms (2.9%), six or more IN symptoms (2.5%), or six or more of both HI and IN symptoms (2.2%) are similar with previous research (e.g., Tercyak et al., 2002). Fig. 1, Fig. 2 show the estimated smoking trajectories over
Discussion
To our knowledge, this is the first study to examine the effect of ADHD symptoms on smoking trajectories as functions of race and gender in a U.S. population-based sample. Another unique feature of this study is the simultaneous modeling of both binary and count smoking trajectories.
The observed cigarette trajectories as a function of race and gender, but independent of ADHD symptoms, are comparable to Chen and Jacobson's (2012) results, which were also derived from Add Health data. Overall, in
Role of funding source
This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for
Contributors
Chien-Ti Lee and Bernard Fuemmeler designed the study in conjunct with Joseph McClernon and Scott Kollins. Chien-Ti Lee managed the literature search, undertook the statistical analysis, and completed the first draft of the manuscript. Trenette Clark summarized previous related work and edited the subsequent revisions of the manuscripts. All authors contributed to the editing the final draft of the manuscript and have approved the final version.
Conflict of interest
None declared.
References (38)
- et al.
Association between hyperactivity and executive cognitive function in childhood and substance use in early adolescence
J. Am. Acad. Child Adolesc. Psychiatry
(1999) - et al.
Developmental trajectories of substance use from early adolescence to young adulthood: gender and racial/ethnic differences
J. Adolesc. Health
(2012) - et al.
Which adolescent experimenters progress to established smoking in the United States
Am. J. Prev. Med.
(1997) - et al.
Alcohol use from ages 9 to 16: a cohort-sequential latent growth model
Drug Alcohol Depend.
(2006) - et al.
Patterns of comorbidity associated with subtypes of attention-deficit/hyperactivity disorder among 6- to 12-year-old children
J. Am. Acad. Child Adolesc. Psychiatry
(1997) - et al.
Black-White differences in cigarette smoking uptake: progression from adolescent experimentation to regular use
Prev. Med.
(1998) - et al.
Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample
Drug Alcohol Depend.
(2013) - et al.
Age-related differences in cigarette smoking among Whites and African-Americans: evidence for the crossover hypothesis
Drug Alcohol Depend.
(2011) - et al.
Nicotine differentially inhibits the acoustic startle reflex in African American and Caucasian American smokers
Addict. Behav.
(2008) - et al.
Implications of extending the ADHD age-of-onset criterion to age 12: results from a prospectively studied birth cohort
J. Am. Acad. Child Adolesc. Psychiatry
(2010)
Identifying the facets of impulsivity that explain the relation between ADHD symptoms and substance use in a nonclinical sample
Addict. Behav.
Association of attention-deficit/hyper activity disorder symptoms with levels of cigarette smoking in a community sample of adolescents
J. Am. Acad. Child Adolesc. Psychiatry
Sex ADHD symptoms, and smoking outcomes: an integrative model
Med. Hypotheses
Racial differences in trajectories of cigarette use
Drug Alcohol Depend.
Does ADHD predicit substance-use disorders? A 10-year follow-up study of young adults with ADHD
J Am Acad Child Adolesc Psychiatry
Do ethnicity and gender moderate the influence of posttraumatic stress disorder on time to smoking lapse
Addict. Behav.
Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity
J. Consult. Clin. Psychol.
Latent Curve Models: A Structural Equation Perspective
Which aspects of ADHD are associated with tobacco use in early adolescence
J. Child Psychol. Psychiatry
Cited by (7)
Cannabis Use and Internalizing/Externalizing Symptoms in Youth: A Canadian Population-Based Study
2020, Journal of Adolescent HealthCitation Excerpt :In our study, smoking was associated with elevated externalizing and internalizing symptoms in the female models, while being nonsignificant in the male models. This is supported by other literature showing sex-based differences in the association between smoking and poor mental health [26–28]. Binge drinking showed an association with elevated externalizing and internalizing symptoms in all the models, except for the female-internalizing model.
Stress, attention deficit hyperactivity disorder (ADHD) symptoms and tobacco smoking: The i-Share study
2017, European PsychiatryCitation Excerpt :In particular, shared genetic/environmental vulnerability and clinical/neurocognitive characteristics could make people with ADHD more likely to consume tobacco [18]. Of note, the gender effect in the relationship between ADHD and tobacco use remains unclear owing to scarce data and contradictory results [19,20]. Limitations in the literature regarding the links between tobacco smoking, stress and ADHD are manifold.
Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men
2019, European Archives of Psychiatry and Clinical Neuroscience