A recent study published in JAMA Network Open sheds new light on the relationship between attention-deficit hyperactivity disorder (ADHD) and the increased likelihood of tobacco and e-cigarette use among youths. The research aimed to determine if youths with symptomatic and asymptomatic ADHD are more prone to engaging in nicotine use compared to those without the condition.
The Impact of Tobacco Use on ADHD
Tobacco consumption is a major contributor to various diseases and remains one of the leading causes of global mortality. While previous studies have established a connection between ADHD and tobacco use, the rapid rise of electronic nicotine delivery systems (e-cigarettes) raises new concerns. Since e-cigarette usage surpassed traditional cigarette smoking in 2018, it has quickly become one of the most common substance use behaviors.
ADHD, which is characterized by hyperactivity, inattention, and functional impairment, affects a significant portion of U.S. children and adolescents. Current estimates suggest that one in nine children in the U.S. has been diagnosed with ADHD, and over half of these youths are treated with ADHD medication. With nearly 44% of affected youths receiving psychosocial treatment, ADHD management remains a critical issue.
A meta-analysis has shown that youths with ADHD are at a considerably higher risk of engaging in nicotine use during adolescence compared to their peers without ADHD. Additionally, a Swedish study found that impulsive symptoms associated with ADHD were linked to early tobacco use, raising concerns about the long-term effects of early nicotine exposure on mental health and substance use.
About the Study
This cohort study aimed to further explore the connection between ADHD and tobacco use, particularly considering how different ADHD symptoms contribute to this relationship. Researchers analyzed data from 13,651 U.S. youths, ages 12 to 17, using information gathered from the Population Assessment of Tobacco and Health (PATH) Study.
Survey data was collected in seven waves between September 2013 and April 2023, with participants providing information on their use of a wide range of nicotine and tobacco products, including e-cigarettes, vape pens, cigarettes, cigars, smokeless tobacco, and more.
Participants were classified into three groups: those diagnosed with ADHD and prescribed pharmacotherapy, those diagnosed with ADHD without pharmacotherapy, and a control group consisting of youths without ADHD. ADHD symptom severity was also assessed, categorizing youths into three levels of symptom intensity.
Study Findings
Of the 13,572 participants, 51.3% were male, and 50.4% were between the ages of 12 and 14. Roughly 14% had an ADHD diagnosis, with 57.9% of these youths receiving pharmacotherapy. The analysis revealed that youths with asymptomatic ADHD, whether or not they were on medication, had a similar likelihood of initiating tobacco use compared to those in the control group over the nine-year study period.
However, youths with more severe ADHD symptoms—whether or not they had received pharmacotherapy—were significantly more likely to initiate tobacco and e-cigarette use. In particular, those with highly symptomatic ADHD who were prescribed medication were more likely to become regular tobacco users, compared to those with fewer symptoms or no symptoms of ADHD.
Conclusions
This study underscores the strong link between ADHD symptoms and increased risk of tobacco and e-cigarette use among U.S. youths. The findings highlight the importance of early diagnosis and comprehensive management of ADHD to mitigate the risk of future nicotine use, potentially preventing long-term health consequences for affected individuals.
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