Symptom control may curb the higher odds of nicotine, tobacco use in adolescents with ADHD

Key takeaways:

• Those with three or more ADHD symptoms had the greatest odds for nicotine and tobacco use.
• The findings suggest that ADHD treatment, therapy or symptom dissipation can help lower these odds.

Adolescents in the United States with symptoms of ADHD had a higher likelihood of using tobacco and other nicotine-based products, results from a cohort study published in JAMA Network Open showed.

Those with a greater number of symptoms experienced the largest risk for such outcomes, whereas the results show that earlier identification and treatment of the disorder “can help alleviate ADHD symptoms and make people less susceptible to starting tobacco and nicotine use,” Sean Esteban McCabe, PhD, a professor at the University of Michigan School of Nursing, told Healio.

According to McCabe and colleagues, the prevalences of e-cigarette use, ADHD diagnoses and pharmacotherapy treatment for ADHD have all risen over the last several years.

They pointed out that there have been no previous studies examining links between ADHD and later tobacco or nicotine use “that have parsed out the nuances of ADHD treatment and ADHD symptom severity.”

In the analysis, the researchers assessed how those factors influenced the odds for several outcomes of tobacco and nicotine use over a 9-year period among a sample of 13,572 adolescents aged 12 to 17 years from the Population Assessment of Tobacco and Study.

They used data on history of ADHD diagnosis, pharmacotherapy treatment and ADHD symptom severity to create nine different subgroups.

Study investigators defined one or two symptoms as lower ADHD symptom severity and higher for three or more symptoms, while incident outcomes included e-cigarette use, cigarette smoking, other tobacco use and dual nicotine and tobacco use.

Overall, 14.1% of the study cohort received an ADHD diagnosis.

The odds for cigarette smoking, e-cigarette use, other tobacco use and dual use did not significantly differentiate between the population controls and adolescents with asymptomatic ADHD, either with or without pharmacotherapy.

However, all the adolescent subgroups with three or more ADHD symptoms had a greater likelihood for most of the outcomes vs. population controls, regardless of pharmacotherapy status.

For example, youth with three or more symptoms and who received pharmacotherapy had greater odds of e-cigarette use (adjusted OR = 1.6; 95% CI, 1.34-2.04),

cigarette smoking (aOR = 1.52; 95% CI, 1.22-1.89), other tobacco use (aOR = 1.61; 95% CI, 1.27-2.02) and dual use (aOR = 1.72; 95% CI, 1.38-2.14).

Among adolescents with ADHD, those with higher symptomatic ADHD receiving pharmacotherapy appeared much likelier to initiate e-cigarette (aOR = 1.68; 95% CI, 1.16-2.44) and dual use (aOR = 1.82; 95% CI, 1.17-2.83) vs. asymptomatic youth receiving the treatment.

The odds for all outcomes among those with lower symptomatic ADHD fell between those with higher severity and asymptomatic individuals. “While the majority of youth who had many symptoms of ADHD (eg, forgetfulness, inattention, hyperactivity) went on to start e-cigarette use in the subsequent 9-year period, this was not true for youth with fewer or no ADHD symptoms,” McCabe underlined as the most takeaway from the results.

“These findings are a really big deal because it is well-established that people with ADHD are more likely to use tobacco and nicotine, but this study suggests that if their symptoms of ADHD are controlled through therapy, medications, or if the symptoms naturally dissipate — they remain at lower risk for tobacco and nicotine and associated adverse outcomes,” he told Healio.

He added that further research on links between the disorder’s symptoms and other substance use is warranted “because there are a lot of people with ADHD and parents of children with ADHD who want to manage ADHD symptoms and reduce problems.”

Ultimately, “the more youth with ADHD who do not start using tobacco or nicotine, or who quit, the longer their life expectancy will be,” McCabe said.