title: Preliminary evidence that adherence to counseling mediates the effects of pretreatment self-efficacy and motivation on outcome of a cessation attempt in smokers with ADHD.
abstract: BACKGROUND
  Few studies have evaluated predictors of smoking cessation outcomes in smokers with attention-deficit/hyperactivity disorder (ADHD), which could help to improve suboptimal treatment outcomes in this population. The purpose of this study was to examine pretreatment thoughts about smoking abstinence (i.e., desire to quit, perceived difficulty quitting, and expected success in quitting) as predictors of smoking cessation outcomes in smokers with ADHD and to determine the extent to which treatment adherence mediates these relationships.
  
  
  METHODS
  Participants were adult smokers with ADHD (n = 255), who were enrolled in a multisite smoking cessation study and received either osmotic-release oral system methylphenidate (OROS-MPH) or placebo in combination with transdermal nicotine replacement and brief cessation counseling. Bootstrapped logistic regression models were generated to test main effects of thoughts about abstinence on smoking cessation outcomes and to examine treatment adherence as a mediator of these relationships.
  
  
  RESULTS
  Desire to quit and expected success in quitting, but not perceived difficulty quitting, predicted smoking cessation outcomes, as did all of the treatment adherence variables (i.e., percent sessions attended, counselor ratings of counseling adherence, and percent patch adherence). Counseling adherence partially mediated the relationship between smoking cessation outcomes and both pretreatment desire to quit and expected success.
  
  
  CONCLUSIONS
  Smokers with ADHD who have higher self-efficacy (i.e., expected success) and motivation (i.e., desire) to quit are more adherent to smoking cessation counseling and have better smoking cessation outcomes. Additional research is needed to determine whether treatment-seeking smokers with ADHD would benefit from an intervention designed to increase self-efficacy and motivation to quit.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine Cincinnati, OH 45219, USA. Jaimee.Heffner@uc.edu
authors.forename: Jaimee L
authors.initials: JL
authors.lastname: Heffner
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Lewis
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Winhusen
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000523:psychology*; D003376:Counseling; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000008:administration & dosage; D010349:Patient Compliance; D010919:Placebos; D020377:Self Efficacy; D016540:Smoking Cessation
chemical_list: D010919:Placebos; D009538:Nicotine