Elsevier

Drug and Alcohol Dependence

Volume 148, 1 March 2015, Pages 180-187
Drug and Alcohol Dependence

Attention Deficit Hyperactivity Disorder symptoms and smoking trajectories: Race and gender differences

https://doi.org/10.1016/j.drugalcdep.2015.01.002Get rights and content

Highlights

  • Attention Deficit Hyperactivity Disorder (ADHD) severity and directionality had unique effects on smoking trajectories.

  • ADHD severity is associated with prevalence of smoking at a young age (age 13).

  • ADHD severity is related to the acceleration of cigarette consumption.

  • ADHD directionality is related to the increasing prevalence of smoking.

  • The risk of ADHD symptoms may differ by race and gender.

Abstract

Purpose

This study examined the influence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms severity and directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) on trajectories of the probability of current (past month) smoking and the number of cigarettes smoked from age 13 to 32. Racial and gender differences in the relationship of ADHD symptoms and smoking trajectories were also assessed.

Methods

A subsample of 9719 youth (54.5% female) was drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Cohort sequential design and zero-inflated Poisson (ZIP) latent growth modeling were used to estimate the relationship between ADHD directionality and severity on smoking development.

Results

ADHD severity's effect on the likelihood of ever smoking cigarettes at the intercept (age 13) had a greater impact on White males than other groups. ADHD severity also had a stronger influence on the initial number of cigarettes smoked at age 13 among Hispanic participants. The relationships between ADHD directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) and a higher number of cigarettes smoked at the intercept were stronger among Hispanic males than others. Gender differences manifested only among Whites.

Conclusion

ADHD severity and directionality had unique effects on smoking trajectories. Our results also highlight that the risk of ADHD symptoms may differ by race and gender.

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)

  • W. Roberts et al.

    Identifying the facets of impulsivity that explain the relation between ADHD symptoms and substance use in a nonclinical sample

    Addict. Behav.

    (2014)
  • K.P. Tercyak et al.

    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

    (2002)
  • E.E. Van Voorhees et al.

    Sex ADHD symptoms, and smoking outcomes: an integrative model

    Med. Hypotheses

    (2012)
  • H.R. White et al.

    Racial differences in trajectories of cigarette use

    Drug Alcohol Depend.

    (2004)
  • T.E. Wilens et al.

    Does ADHD predicit substance-use disorders? A 10-year follow-up study of young adults with ADHD

    J Am Acad Child Adolesc Psychiatry

    (2011)
  • S.M. Wilson et al.

    Do ethnicity and gender moderate the influence of posttraumatic stress disorder on time to smoking lapse

    Addict. Behav.

    (2014)
  • T.D. Armstrong et al.

    Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity

    J. Consult. Clin. Psychol.

    (2002)
  • K.A. Bollen et al.

    Latent Curve Models: A Structural Equation Perspective

    (2006)
  • J.D. Burke et al.

    Which aspects of ADHD are associated with tobacco use in early adolescence

    J. Child Psychol. Psychiatry

    (2001)
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