title: Attention deficit hyperactivity disorder symptoms mediate early-onset smoking.
abstract: OBJECTIVE
  Symptoms of attention deficit hyperactivity disorder (ADHD) have often been associated with early-onset smoking. We hypothesize that reductions in ADHD symptoms due to an intervention have a mediating effect on early-onset smoking.
  
  
  METHODS
  In a universal, school-based, randomized controlled intervention trial, we examined whether intervention-induced reductions in ADHD symptoms at age 9 mediated the reduced risk of tobacco use onset among these children at age 10 or 11 years. A sample of 477 first-grade boys and girls were randomly assigned to the Good Behavior Game intervention (n = 263), a 2-year (grades 2 and 3) universal classroom-based intervention aimed at reducing disruptive behavior problems, or to a control condition (n = 214). ADHD symptoms were assessed through teacher ratings. Early onset of tobacco use was assessed through self-report.
  
  
  RESULTS
  The intervention-induced reductions in ADHD symptoms fully mediated the distal effect of intervention on reductions in early-onset smoking.
  
  
  CONCLUSIONS
  Our results showed that programs that target ADHD symptoms may protect children from early-onset smoking as well. Further research is needed to examine pathways from ADHD symptoms to tobacco use.
authors.affiliation: Erasmus Medical Center Rotterdam/Sophia Children's Hospital, Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands. a.c.huizink@erasmusmc.nl
authors.forename: A C
authors.initials: AC
authors.lastname: Huizink
authors.forename: P A C
authors.initials: PA
authors.lastname: van Lier
authors.forename: A A M
authors.initials: AA
authors.lastname: Crijnen
mesh_terms: D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D000074606:Smoking Prevention