ADHD is associated with early initiation of cigarette smoking in children and adolescents.
OBJECTIVE
The association between attention-deficit hyperactivity disorder (ADHD) and cigarette smoking in children and adolescents was evaluated.


METHODS
Subjects were 6- to 17-year-old boys with DSM-III-R ADHD (n = 128) and non-ADHD comparison boys (n = 109) followed prospectively for 4 years into mid-adolescence. Information on cigarette smoking was obtained in a standardized manner blind to the proband's clinical status. Cox proportional hazard models were used to predict cigarette smoking at follow-up using baseline characteristics as predictors.


RESULTS
ADHD was a significant predictor of cigarette smoking at follow-up into mid-adolescence. Our findings also revealed that ADHD was associated with an early initiation of cigarette smoking. This was the case even after controlling for socioeconomic status, IQ, and psychiatric comorbidity. In addition, among children with ADHD, there was a significant positive association between cigarette smoking and conduct, major depressive, and anxiety disorders.


CONCLUSIONS
ADHD, particularly the comorbid subtype, is a significant risk factor for early initiation of cigarette smoking in children and adolescents. Considering the prevalence and early childhood onset of ADHD, these findings highlight the importance of smoking prevention and cessation programs for children and adolescents with ADHD.
Milberger
S
S
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
Biederman
J
J
Faraone
S V
SV
Chen
L
L
Jones
J
J
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009497:Neurotic Disorders / Q000453:epidemiology; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology