title: Stimulant treatment of ADHD and cigarette smoking: a meta-analysis.
abstract: OBJECTIVE
  Individuals with attention-deficit/hyperactivity disorder (ADHD) have a significantly higher risk of cigarette smoking. The nature of the relationship between smoking and psychostimulant medications commonly used to treat ADHD is controversial. Our objective was to examine the relationship between stimulant treatment of ADHD and cigarette smoking by using meta-analysis, and to identify study and sample characteristics that moderate this relationship.
  
  
  METHODS
  Literature searches on PubMed and PsycInfo databases identified published studies for inclusion. Included studies compared cigarette smoking outcomes for stimulant-treated and untreated ADHD individuals. Seventeen studies met inclusion criteria, and 14 (total n = 2360) contained sufficient statistical information for inclusion in the meta-analysis. Two authors extracted odds ratios or frequencies of smokers in the treatment or nontreatment groups, and coded study characteristics including sample source, percentage of male participants, follow-up length, treatment consistency, type of smoking measure, prospective study, and controlling for comorbidities.
  
  
  RESULTS
  Meta-analysis revealed a significant association between stimulant treatment and lower smoking rates. Meta-regression indicated that effect sizes were larger for studies that used clinical samples, included more women, measured smoking in adolescence rather than adulthood, conceptualized stimulant treatment as consistent over time, and accounted for comorbid conduct disorder.
  
  
  CONCLUSIONS
  Nearly all studies were naturalistic, precluding causal inferences. Available data were insufficient to examine additional influences of patient demographics, treatment effectiveness, or other comorbidities. Consistent stimulant treatment of ADHD may reduce smoking risk; the effect was larger in samples with more severe psychopathology. Implications for further research, treatment of ADHD, and smoking prevention are discussed.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina; and ESchoenfelder@gmail.com.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Schoenfelder
authors.affiliation: Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina; and.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Kollins
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012306:Risk; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D013223:Statistics as Topic; D014029:Tobacco Use Disorder / Q000453:epidemiology; D014481:United States; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants
keywords: ADHD; cigarette smoking; meta-analysis; psychostimulant medication